LOUIS VAN DER WA FOURIE Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****64

License Status

NOT RENEWED

Business

First Name

LOUIS VAN DER WA

Last Name

FOURIE

Business Name

LOUIS VAN DER WA FOURIE

Original Issue Date

01/01/1998

Expiration Date

09/30/1990

City

ROCKFORD

State

Zip

61107

County

BOONE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005