DANIEL ROBERT JACOBSEN Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****76

License Status

ACTIVE

Business

First Name

DANIEL

Middle

ROBERT

Last Name

JACOBSEN

Business Name

DANIEL ROBERT JACOBSEN

Original Issue Date

06/07/2011

Effective Date

07/08/2024

Expiration Date

09/30/2027

City

BLOOMINGTON

State

Zip

61704

County

MCLEAN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/08/2024