JAMES EDWARD PETERSEN Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****22

License Status

NOT RENEWED

Business

First Name

JAMES EDWARD

Last Name

PETERSEN

Business Name

JAMES EDWARD PETERSEN

Original Issue Date

01/01/1998

Expiration Date

09/30/2004

City

OREGON

State

Zip

61061

County

OGLE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005