EDWARD J DIESTELKAMP JR DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****93

License Status

NOT RENEWED

Business

First Name

EDWARD J

Last Name

DIESTELKAMP JR

Suffix

DDS

Business Name

EDWARD J DIESTELKAMP JR DDS

Original Issue Date

01/01/1998

Effective Date

08/31/2012

Expiration Date

09/30/2015

City

GODREY

State

Zip

62035

County

MADISON

Controlled Substance Schedule

II III

Ever Disciplined

LastModifiedDate

02/08/2016