MICHAEL JAMES FOSSELMAN DDS Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****71

License Status

CANCELLED

Business

First Name

MICHAEL JAMES

Last Name

FOSSELMAN

Suffix

DDS

Business Name

MICHAEL JAMES FOSSELMAN DDS

Original Issue Date

01/01/1998

Expiration Date

09/30/1986

City

PEORIA

State

Zip

61614

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005