CHARLES FREDERIC NICHOLS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****08

License Status

NOT RENEWED

Business

First Name

CHARLES FREDERIC

Last Name

NICHOLS

Business Name

CHARLES FREDERIC NICHOLS

Original Issue Date

01/01/1998

Expiration Date

09/30/2006

City

ROCKFORD

State

Zip

61101

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2007