MICHAELLA RADICH HEITZLER DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000892

License Status

NOT RENEWED

Business

Title

DMD

First Name

MICHAELLA

Middle

RADICH

Last Name

HEITZLER

Business Name

MICHAELLA RADICH HEITZLER DMD

Original Issue Date

06/03/2014

Effective Date

06/03/2014

Expiration Date

09/30/2015

City

CHICAGO

State

Zip

60647

County

WISCONSIN

Specialty/Qualifier

CONSCIOUS SEDATION, PARENTERAL

Ever Disciplined

LastModifiedDate

02/08/2016