MARK K BURGESS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****51

License Status

ACTIVE

Business

First Name

MARK K

Last Name

BURGESS

Business Name

MARK K BURGESS

Original Issue Date

08/18/1987

Effective Date

05/10/2024

Expiration Date

09/30/2027

City

BLOOMINGTON

State

Zip

61701

County

MCLEAN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/10/2024