MARK JOSHUA PAYNE DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****32

License Status

NOT RENEWED

Business

Title

DMD

First Name

MARK

Middle

JOSHUA

Last Name

PAYNE

Business Name

MARK JOSHUA PAYNE DMD

Original Issue Date

09/05/2012

Effective Date

11/12/2015

Expiration Date

09/30/2018

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018