DAVID J DEPORTER DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****97

License Status

NOT RENEWED

Business

First Name

DAVID

Middle

Last Name

DEPORTER

Suffix

DDS

Business Name

DAVID J DEPORTER DDS

Original Issue Date

01/01/1998

Expiration Date

09/30/1990

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005