DAVID C NILES Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****43

License Status

NOT RENEWED

Business

First Name

DAVID C

Last Name

NILES

Business Name

DAVID C NILES

Original Issue Date

08/10/1987

Effective Date

12/21/2021

Expiration Date

09/30/2024

City

DEFOREST

State

Zip

53532

County

WISCONSIN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025