CHARLES H EKSTROM DDS Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****22

License Status

CANCELLED

Business

First Name

CHARLES H

Last Name

EKSTROM

Suffix

DDS

Business Name

CHARLES H EKSTROM DDS

Original Issue Date

01/01/1998

Expiration Date

09/30/2002

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

10/17/2005