DAVID J DOMBEK Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****53

License Status

NOT RENEWED

Business

First Name

DAVID J

Last Name

DOMBEK

Business Name

DAVID J DOMBEK

Original Issue Date

10/01/1998

Effective Date

10/01/1998

Expiration Date

09/30/2004

City

GRANITE CITY

State

Zip

62040

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005