DAVID A DIAK DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****08

License Status

NOT RENEWED

Business

First Name

DAVID A

Last Name

DIAK

Suffix

DMD

Business Name

DAVID A DIAK DMD

Original Issue Date

10/18/1990

Effective Date

10/18/1990

Expiration Date

09/30/1998

City

GRANITE CITY

State

Zip

62040

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005