KENNETH L MYRACLE Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****39

License Status

ACTIVE

Business

First Name

KENNETH L

Last Name

MYRACLE

Business Name

KENNETH L MYRACLE

Original Issue Date

09/26/1988

Effective Date

06/05/2024

Expiration Date

09/30/2027

City

MATTOON

State

Zip

61938

County

COLES

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/05/2024