MARK DARIN BLACK Dentist License verification

Business Entity

INOPERATIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****27

License Status

INOPERATIVE

Business

First Name

MARK DARIN

Last Name

BLACK

Business Name

MARK DARIN BLACK

Original Issue Date

11/13/1995

Effective Date

11/13/1995

Expiration Date

09/30/1998

City

CHAMPAIGN

State

Zip

61820

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005