MARK D MACEK DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****00

License Status

NOT RENEWED

Business

First Name

MARK D

Last Name

MACEK

Suffix

DDS

Business Name

MARK D MACEK DDS

Original Issue Date

10/19/1992

Effective Date

10/19/1992

Expiration Date

09/30/1994

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005