REBECCA J FORNERO Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****66

License Status

NOT RENEWED

Business

First Name

REBECCA J

Last Name

FORNERO

Business Name

REBECCA J FORNERO

Original Issue Date

09/24/2002

Effective Date

08/21/2015

Expiration Date

09/30/2018

City

COLLINSVILLE

State

Zip

62234

County

MADISON

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

10/31/2018