LORI ANN FULK Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****56

License Status

NOT RENEWED

Business

First Name

LORI

Middle

ANN

Last Name

FULK

Business Name

LORI ANN FULK

Original Issue Date

12/30/2002

Effective Date

07/24/2006

Expiration Date

09/30/2009

City

PEORIA

State

Zip

61614

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009