NELS OWEN EWOLDSEN DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****00

License Status

NOT RENEWED

Business

First Name

NELS

Middle

OWEN

Last Name

EWOLDSEN

Suffix

DDS

Business Name

NELS OWEN EWOLDSEN DDS

Original Issue Date

07/06/2010

Effective Date

07/06/2010

Expiration Date

09/30/2012

City

PARIS

State

Zip

61944

County

EDGAR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012