MARK M ORTINAU DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****24

License Status

NOT RENEWED

Business

Title

DDS

First Name

MARK

Middle

Last Name

ORTINAU

Business Name

MARK M ORTINAU DDS

Original Issue Date

03/17/2015

Effective Date

09/18/2015

Expiration Date

09/30/2018

City

VANDALIA

State

Zip

62471

County

FAYETTE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018