MICHAEL DAVID DEGOULD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000269

License Status

ACTIVE

Business

First Name

MICHAEL DAVID

Last Name

DEGOULD

Business Name

MICHAEL DAVID DEGOULD

Original Issue Date

09/21/1990

Effective Date

05/02/2024

Expiration Date

09/30/2027

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Specialty/Qualifier

Deep Sedation and General Anesthesia

Ever Disciplined

LastModifiedDate

05/02/2024