SHANE MICHAEL VAN VLEET DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****13

License Status

NOT RENEWED

Business

First Name

SHANE

Middle

MICHAEL

Last Name

VAN VLEET

Suffix

DMD

Business Name

SHANE MICHAEL VAN VLEET DMD

Original Issue Date

03/26/2008

Effective Date

09/22/2015

Expiration Date

09/30/2018

City

MACOMB

State

Zip

61455

County

MCDONOUGH

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018