LISA D CLARK Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020010456

License Status

NOT RENEWED

Business

First Name

LISA

Middle

Last Name

CLARK

Business Name

LISA D CLARK

Original Issue Date

08/22/2002

Effective Date

10/01/2012

Expiration Date

09/30/2015

City

DOUGLASVILLE

State

Zip

30135

County

GEORGIA

Ever Disciplined

LastModifiedDate

04/25/2016