JACK EDGAR OSTERHAUS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****79

License Status

NOT RENEWED

Business

First Name

JACK

Middle

EDGAR

Last Name

OSTERHAUS

Business Name

JACK EDGAR OSTERHAUS

Original Issue Date

09/26/2013

Effective Date

09/26/2013

Expiration Date

09/30/2015

City

LA SALLE

State

Zip

61301

County

LA SALLE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016