MARCIN M JASEK DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****58

License Status

NOT RENEWED

Business

Title

DDS

First Name

MARCIN

Middle

Last Name

JASEK

Business Name

MARCIN M JASEK DDS

Original Issue Date

05/29/2014

Effective Date

05/29/2014

Expiration Date

09/30/2015

City

ROCKFORD

State

Zip

61114

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016