DAVID FREDERICK FOSS DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****65

License Status

NOT RENEWED

Business

First Name

DAVID

Middle

FREDERICK

Last Name

FOSS

Suffix

DDS

Business Name

DAVID FREDERICK FOSS DDS

Original Issue Date

05/27/2008

Effective Date

05/27/2008

Expiration Date

09/30/2009

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009