DAVID D DOMENELLA Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****74

License Status

NOT RENEWED

Business

First Name

DAVID D

Last Name

DOMENELLA

Business Name

DAVID D DOMENELLA

Original Issue Date

02/23/1987

Effective Date

02/23/1987

Expiration Date

09/30/1988

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005