RICHARD G KANTWILL 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

RICHARD G

Last Name

KANTWILL

Business Name

RICHARD G KANTWILL

Original Issue Date

03/05/1993

Effective Date

03/05/1993

Expiration Date

09/30/1996

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005