JENNIFER ANN BLANK Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020011224

License Status

NOT RENEWED

Business

First Name

JENNIFER

Middle

ANN

Last Name

BLANK

Business Name

JENNIFER ANN BLANK

Original Issue Date

01/13/2005

Effective Date

09/30/2004

Expiration Date

09/30/2006

City

KENOSHA

State

Zip

53142

County

WISCONSIN

Ever Disciplined

LastModifiedDate

11/08/2006