MARK A STEPHENS DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****29

License Status

NOT RENEWED

Business

Title

DMD

First Name

MARK

Middle

Last Name

STEPHENS

Business Name

MARK A STEPHENS DMD

Original Issue Date

07/15/2010

Effective Date

07/15/2010

Expiration Date

09/30/2012

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012