ANDREW MARSHALL CLARK DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****30

License Status

NOT RENEWED

Business

First Name

ANDREW

Middle

MARSHALL

Last Name

CLARK

Suffix

DDS

Business Name

ANDREW MARSHALL CLARK DDS

Original Issue Date

08/21/2007

Effective Date

06/19/2009

Expiration Date

09/30/2012

City

DOWNERS GROVE

State

Zip

60516

County

DUPAGE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012