MARK THEODORE GAPONIUK DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****64

License Status

NOT RENEWED

Business

First Name

MARK

Middle

THEODORE

Last Name

GAPONIUK

Suffix

DMD

Business Name

MARK THEODORE GAPONIUK DMD

Original Issue Date

06/09/2000

Effective Date

06/09/2000

Expiration Date

09/30/2002

City

STRONGHURST

State

Zip

61480

County

HENDERSON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005