SUSAN J ELLENZ DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****51

License Status

NOT RENEWED

Business

First Name

SUSAN J

Last Name

ELLENZ

Suffix

DDS

Business Name

SUSAN J ELLENZ DDS

Original Issue Date

05/15/1986

Effective Date

10/01/2012

Expiration Date

09/30/2015

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016