MITCHELL W PELSUE Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****90

License Status

NOT RENEWED

Business

First Name

MITCHELL W

Last Name

PELSUE

Business Name

MITCHELL W PELSUE

Original Issue Date

06/12/2008

Effective Date

06/12/2008

Expiration Date

09/30/2009

City

ROSCOE

State

Zip

61073

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009