MICHELLE R BLACK Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020006439

License Status

INACTIVE

Business

First Name

MICHELLE R

Last Name

BLACK

Business Name

MICHELLE R BLACK

Original Issue Date

07/18/1987

Effective Date

09/28/2018

Expiration Date

01/31/2022

City

MATTOON

State

Zip

61938

County

COLES

Ever Disciplined

LastModifiedDate

01/19/2022