PHILIP EZRA CLARK DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019013326

License Status

NOT RENEWED

Business

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

City

QUINCY

State

Zip

62301

County

ADAMS

Ever Disciplined

LastModifiedDate

01/08/2010