NELS OWEN EWOLDSEN DDS 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

NELS

Middle

OWEN

Last Name

EWOLDSEN

Suffix

DDS

Business Name

NELS OWEN EWOLDSEN DDS

Original Issue Date

07/22/2010

Effective Date

07/22/2010

Expiration Date

09/30/2012

City

DANVILLE

State

Zip

61834

County

VERMILION

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012