DAVID MICHAEL CLARK DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****57

License Status

NOT RENEWED

Business

First Name

DAVID

Middle

MICHAEL

Last Name

CLARK

Suffix

DDS

Business Name

DAVID MICHAEL CLARK DDS

Original Issue Date

08/05/2009

Effective Date

12/10/2012

Expiration Date

09/30/2015

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016