TARAH ANN RIDENBARK DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****24

License Status

NOT RENEWED

Business

Title

DMD

First Name

TARAH

Middle

ANN

Last Name

RIDENBARK

Business Name

TARAH ANN RIDENBARK DMD

Original Issue Date

06/16/2016

Effective Date

06/16/2016

Expiration Date

09/30/2018

City

WORDEN

State

Zip

62097

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018