KIM E DIEFENDERFER Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****70

License Status

NOT RENEWED

Business

First Name

KIM E

Last Name

DIEFENDERFER

Business Name

KIM E DIEFENDERFER

Original Issue Date

11/04/1985

Effective Date

11/04/1985

Expiration Date

09/30/1986

City

GREAT LAKES

State

Zip

60088

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005