MARA K GANIM DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****02

License Status

NOT RENEWED

Business

Title

DMD

First Name

MARA

Middle

Last Name

GANIM

Business Name

MARA K GANIM DMD

Original Issue Date

06/08/2015

Effective Date

09/23/2019

Expiration Date

01/31/2022

City

O FALLON

State

Zip

62269

County

SAINT CLAIR

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022