KJERSTEN ANN OTTERHOLT Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****14

License Status

NOT RENEWED

Business

First Name

KJERSTEN

Middle

ANN

Last Name

OTTERHOLT

Business Name

KJERSTEN ANN OTTERHOLT

Original Issue Date

07/03/2013

Effective Date

07/03/2013

Expiration Date

09/30/2015

City

STRONGHURST

State

Zip

61480

County

HENDERSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016