CLARK W MARTINEAU DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****28

License Status

NOT RENEWED

Business

First Name

CLARK W

Last Name

MARTINEAU

Suffix

DMD

Business Name

CLARK W MARTINEAU DMD

Original Issue Date

01/29/1992

Effective Date

01/29/1992

Expiration Date

09/30/2002

City

CENTRALIA

State

Zip

62801

County

MARION

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005