DUANE DAVID HANSEN Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****87

License Status

INACTIVE

Business

First Name

DUANE

Middle

DAVID

Last Name

HANSEN

Business Name

DUANE DAVID HANSEN

Original Issue Date

06/22/2021

Effective Date

06/22/2021

Expiration Date

09/30/2024

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/01/2024