FREDRIC ROSS FIERSTEN DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****86

License Status

NOT RENEWED

Business

Title

DDS

First Name

FREDRIC

Middle

ROSS

Last Name

FIERSTEN

Business Name

FREDRIC ROSS FIERSTEN DDS

Original Issue Date

01/01/1998

Effective Date

09/14/2009

Expiration Date

09/30/2012

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012