RICHARD MARK PORT DDS - Dentist License in Illinois | # 021001133

RICHARD MARK PORT DDS

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED SPECIALIST IN DENTISTRY

License Number

021001133

License Status

NOT RENEWED

Business

N

First Name

RICHARD MARK

Last Name

PORT

Suffix

DDS

Business Name

RICHARD MARK PORT DDS

Original Issue Date

07/16/1982

Effective Date

10/22/2021

Expiration Date

09/30/2024

State

IL

Specialty/Qualifier

Pediatric Dentist

Ever Disciplined

N

LastModifiedDate

02/04/2025