JACQUELYN NANCY JOHANSEN Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020009641

License Status

INACTIVE

Business

First Name

JACQUELYN

Middle

NANCY

Last Name

JOHANSEN

Business Name

JACQUELYN NANCY JOHANSEN

Original Issue Date

10/06/1999

Effective Date

06/18/2009

Expiration Date

09/30/2012

City

TUALATIN

State

Zip

97062

County

WASHINGTON

Ever Disciplined

LastModifiedDate

06/06/2012