DANIEL JOSEPH ROVELSTAD DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****37

License Status

NOT RENEWED

Business

First Name

DANIEL

Middle

JOSEPH

Last Name

ROVELSTAD

Suffix

DMD

Business Name

DANIEL JOSEPH ROVELSTAD DMD

Original Issue Date

09/21/2005

Effective Date

09/13/2012

Expiration Date

09/30/2015

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016