SHANNON ELIZABETH NOVAK DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****14

License Status

NOT RENEWED

Business

Title

DMD

First Name

SHANNON

Middle

ELIZABETH

Last Name

NOVAK

Business Name

SHANNON ELIZABETH NOVAK DMD

Original Issue Date

04/17/2014

Effective Date

04/17/2014

Expiration Date

09/30/2015

City

WHITE HALL

State

Zip

62092

County

GREENE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016