KYLE ALLEN CLARK DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****32

License Status

ACTIVE

Business

Title

DMD

First Name

KYLE

Middle

ALLEN

Last Name

CLARK

Business Name

KYLE ALLEN CLARK DMD

Original Issue Date

07/06/2016

Effective Date

07/08/2024

Expiration Date

09/30/2027

City

SALEM

State

Zip

62881

County

MARION

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/08/2024