KELLY JAMES CLARK DDS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****61

License Status

ACTIVE

Business

First Name

KELLY

Middle

JAMES

Last Name

CLARK

Suffix

DDS

Business Name

KELLY JAMES CLARK DDS

Original Issue Date

12/22/2003

Effective Date

05/04/2024

Expiration Date

09/30/2027

City

DECATUR

State

Zip

62521

County

MACON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/04/2024