LAURA MICHELLE POLIS DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****19

License Status

NOT RENEWED

Business

First Name

LAURA

Middle

MICHELLE

Last Name

POLIS

Suffix

DMD

Business Name

LAURA MICHELLE POLIS DMD

Original Issue Date

04/19/1999

Effective Date

04/19/1999

Expiration Date

09/30/2006

City

ROCK ISLAND

State

Zip

61201

County

ROCK ISLAND

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/08/2006