DAVID A DIAK DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****09

License Status

ACTIVE

Business

First Name

DAVID A

Last Name

DIAK

Suffix

DMD

Business Name

DAVID A DIAK DMD

Original Issue Date

02/26/1997

Effective Date

08/13/2024

Expiration Date

09/30/2027

City

GRANITE CITY

State

Zip

62040

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/13/2024