LAWRENCE EUGENE NEWQUIST Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****53

License Status

NOT RENEWED

Business

First Name

LAWRENCE EUGENE

Last Name

NEWQUIST

Business Name

LAWRENCE EUGENE NEWQUIST

Original Issue Date

06/05/1986

Effective Date

06/05/1986

Expiration Date

09/30/1992

City

GODFREY

State

Zip

62035

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005