JACOB ROSS SIMONOVICH DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****35

License Status

NOT RENEWED

Business

Title

DDS

First Name

JACOB

Middle

ROSS

Last Name

SIMONOVICH

Business Name

JACOB ROSS SIMONOVICH DDS

Original Issue Date

11/06/2017

Effective Date

11/06/2017

Expiration Date

09/30/2018

City

MILWAUKEE

State

Zip

53202

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018