MARK JAMES BLACK DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018000687

License Status

NOT RENEWED

Business

Title

DDS

First Name

MARK

Middle

JAMES

Last Name

BLACK

Business Name

MARK JAMES BLACK DDS

Original Issue Date

05/27/1993

Effective Date

05/27/1993

Expiration Date

07/01/1994

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

General Practice Residency

Ever Disciplined

LastModifiedDate

10/12/2005