MARK STEPHEN FRIEDERICH DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****16

License Status

NOT RENEWED

Business

First Name

MARK STEPHEN

Last Name

FRIEDERICH

Suffix

DMD

Business Name

MARK STEPHEN FRIEDERICH DMD

Original Issue Date

01/01/1998

Effective Date

06/26/2009

Expiration Date

09/30/2012

City

TROY

State

Zip

62294

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012