NOMITA S MEHTA Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****18

License Status

NOT RENEWED

Business

First Name

NOMITA

Middle

Last Name

MEHTA

Business Name

NOMITA S MEHTA

Original Issue Date

03/02/2001

Effective Date

03/02/2001

Expiration Date

09/30/2002

City

ROCKFORD

State

Zip

61102

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005