MARLEE GLEN HANSEN 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

Title

DDS

First Name

MARLEE

Middle

GLEN

Last Name

HANSEN

Business Name

MARLEE GLEN HANSEN DDS

Original Issue Date

08/25/2015

Effective Date

06/13/2018

Expiration Date

01/31/2022

City

MATTOON

State

Zip

61938

County

COLES

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022