NICOLE FAITH KOONTZ Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020014279

License Status

INACTIVE

Business

First Name

NICOLE

Middle

FAITH

Last Name

KOONTZ

Business Name

NICOLE FAITH KOONTZ

Original Issue Date

05/23/2013

Effective Date

05/23/2013

Expiration Date

09/30/2015

City

FORT ATKINSON

State

Zip

53538

County

WISCONSIN

Ever Disciplined

LastModifiedDate

06/08/2015