MARISA BLICKHAN DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****56

License Status

ACTIVE

Business

Title

DMD

First Name

MARISA

Last Name

BLICKHAN

Business Name

MARISA BLICKHAN DMD

Original Issue Date

07/16/2024

Effective Date

07/16/2024

Expiration Date

09/30/2027

City

EDWARDSVILLE

State

Zip

62025

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/16/2024