KATELYN KRISTINE MODJESKI DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****67

License Status

NOT RENEWED

Business

First Name

KATELYN

Middle

KRISTINE

Last Name

MODJESKI

Suffix

DDS

Business Name

KATELYN KRISTINE MODJESKI DDS

Original Issue Date

06/27/2012

Effective Date

12/10/2015

Expiration Date

09/30/2018

City

FITCHBURG

State

Zip

53711

County

WISCONSIN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018