LEANNE M FREDRICKSON DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****41

License Status

NOT RENEWED

Business

Title

DDS

First Name

LEANNE

Middle

Last Name

FREDRICKSON

Business Name

LEANNE M FREDRICKSON DDS

Original Issue Date

05/18/1999

Effective Date

05/18/1999

Expiration Date

09/30/2006

City

NORTH CHICAGO

State

Zip

60064

County

LAKE

Controlled Substance Schedule

II IV

Ever Disciplined

LastModifiedDate

01/24/2017