JACK WILLIAM BALENSEIFEN Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED DENTIST

License Number

019013088

License Status

INACTIVE

Business

First Name

JACK WILLIAM

Last Name

BALENSEIFEN

Business Name

JACK WILLIAM BALENSEIFEN

Original Issue Date

07/20/1967

Effective Date

07/20/1967

Expiration Date

09/30/1990

City

BETHANY

State

Zip

73008

County

OKLAHOMA

Ever Disciplined

LastModifiedDate

10/12/2005