GERALD P POULSEN DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019013062

License Status

NOT RENEWED

Business

First Name

GERALD P

Last Name

POULSEN

Suffix

DDS

Business Name

GERALD P POULSEN DDS

Original Issue Date

11/18/1966

Effective Date

11/18/1966

Expiration Date

09/30/1984

City

GRANGER

State

Zip

84119

County

UTAH

Ever Disciplined

LastModifiedDate

10/12/2005