DAVID WARREN JOHNSON Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****34

License Status

NOT RENEWED

Business

First Name

DAVID WARREN

Last Name

JOHNSON

Business Name

DAVID WARREN JOHNSON

Original Issue Date

08/10/1983

Effective Date

07/09/2015

Expiration Date

09/30/2018

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018