KENNETH R JOHNSON 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

KENNETH R

Last Name

JOHNSON

Suffix

DDS

Business Name

KENNETH R JOHNSON DDS

Original Issue Date

12/15/1989

Effective Date

12/15/1989

Expiration Date

09/30/1992

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005