PHILIP EZRA CLARK DDS - Dentist License in Illinois | # 019013326

PHILIP EZRA CLARK DDS

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019013326

License Status

NOT RENEWED

Business

N

First Name

PHILIP EZRA

Last Name

CLARK

Suffix

DDS

Business Name

PHILIP EZRA CLARK DDS

Original Issue Date

07/16/1968

Effective Date

10/01/2006

Expiration Date

09/30/2009

State

IL

Ever Disciplined

N

LastModifiedDate

01/08/2010