PETER B AMUNDSON DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****57

License Status

NOT RENEWED

Business

First Name

PETER B

Last Name

AMUNDSON

Suffix

DMD

Business Name

PETER B AMUNDSON DMD

Original Issue Date

08/10/1995

Effective Date

08/10/1995

Expiration Date

09/30/1998

City

ROCKFORD

State

Zip

61107

County

BOONE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005