JOHN WILLIAM ETZENBACH Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****40

License Status

NOT RENEWED

Business

First Name

JOHN WILLIAM

Last Name

ETZENBACH

Business Name

JOHN WILLIAM ETZENBACH

Original Issue Date

08/02/1982

Effective Date

08/02/1982

Expiration Date

09/30/1996

City

PERU

State

Zip

61354

County

LA SALLE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005