NELS OWEN EWOLDSEN DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****87

License Status

NOT RENEWED

Business

First Name

NELS

Middle

OWEN

Last Name

EWOLDSEN

Suffix

DDS

Business Name

NELS OWEN EWOLDSEN DDS

Original Issue Date

01/06/2011

Effective Date

01/06/2011

Expiration Date

09/30/2012

City

ORLAND PARK

State

Zip

60467

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012