TAMMY D MANDARINO Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****66

License Status

NOT RENEWED

Business

First Name

TAMMY D

Last Name

MANDARINO

Business Name

TAMMY D MANDARINO

Original Issue Date

11/13/1989

Effective Date

11/13/1989

Expiration Date

09/30/2004

City

FITCHBURG

State

Zip

53711

County

WISCONSIN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005