MARK D MILLER Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

RESTRICTED FACULTY LICENSE

License Number

136000015

License Status

NOT RENEWED

Business

First Name

MARK

Middle

Last Name

MILLER

Business Name

MARK D MILLER

Original Issue Date

12/12/1991

Effective Date

12/12/1991

Expiration Date

06/30/1994

City

BELLEVILLE

State

Zip

62221

County

SAINT CLAIR

Ever Disciplined

LastModifiedDate

10/13/2005