DENNIS WAYNE FREDRICKSON DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****78

License Status

ACTIVE

Business

First Name

DENNIS

Middle

WAYNE

Last Name

FREDRICKSON

Suffix

DMD

Business Name

DENNIS WAYNE FREDRICKSON DMD

Original Issue Date

01/30/2007

Effective Date

05/02/2024

Expiration Date

09/30/2027

City

CARBONDALE

State

Zip

62901

County

JACKSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/02/2024