TRISTA EILEEN POTTENGER DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****93

License Status

NOT RENEWED

Business

Title

DMD

First Name

TRISTA

Middle

EILEEN

Last Name

POTTENGER

Business Name

TRISTA EILEEN POTTENGER DMD

Original Issue Date

05/11/2015

Effective Date

09/17/2015

Expiration Date

09/30/2018

City

OGLESBY

State

Zip

61348

County

LA SALLE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018