NATHAN W MOGREN Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****29

License Status

NOT RENEWED

Business

First Name

NATHAN

Middle

Last Name

MOGREN

Business Name

NATHAN W MOGREN

Original Issue Date

07/03/2006

Effective Date

07/03/2006

Expiration Date

09/30/2009

City

MACHESNEY PARK

State

Zip

61115

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009