CLARK MITCHELL STANFORD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****31

License Status

ACTIVE

Business

First Name

CLARK

Middle

MITCHELL

Last Name

STANFORD

Business Name

CLARK MITCHELL STANFORD

Original Issue Date

07/29/2014

Effective Date

07/02/2024

Expiration Date

09/30/2027

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/02/2024