NAIDA M HENRIQUEZ Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****47

License Status

NOT RENEWED

Business

First Name

NAIDA M

Last Name

HENRIQUEZ

Business Name

NAIDA M HENRIQUEZ

Original Issue Date

02/27/1987

Effective Date

02/27/1987

Expiration Date

09/30/1988

City

ROCKFORD

State

Zip

61109

County

WINNEBAGO

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

10/13/2005