ROXANA ELENA DIRLA 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

ROXANA

Middle

ELENA

Last Name

DIRLA

Business Name

ROXANA ELENA DIRLA

Original Issue Date

06/23/2009

Effective Date

06/23/2009

Expiration Date

09/30/2012

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012