DAVID ROBERT MORTENSEN DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****15

License Status

NOT RENEWED

Business

First Name

DAVID ROBERT

Last Name

MORTENSEN

Suffix

DMD

Business Name

DAVID ROBERT MORTENSEN DMD

Original Issue Date

01/01/1998

Effective Date

08/30/2012

Expiration Date

09/30/2015

City

PARK CITY

State

Zip

60085

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016