THERESA NICOLE ADAMCZYK Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****06

License Status

NOT RENEWED

Business

First Name

THERESA

Middle

NICOLE

Last Name

ADAMCZYK

Business Name

THERESA NICOLE ADAMCZYK

Original Issue Date

06/08/2015

Effective Date

06/08/2015

Expiration Date

09/30/2018

City

APPLETON

State

Zip

54911

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018