DEREK R BERQUIST Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019030766

License Status

NOT RENEWED

Business

First Name

DEREK

Middle

Last Name

BERQUIST

Business Name

DEREK R BERQUIST

Original Issue Date

06/24/2016

Effective Date

06/24/2016

Expiration Date

09/30/2018

City

MUNSTER

State

Zip

46321

County

INDIANA

Ever Disciplined

LastModifiedDate

10/31/2018