MARK JAMES BLACK DDS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****67

License Status

ACTIVE

Business

Title

DDS

First Name

MARK

Middle

JAMES

Last Name

BLACK

Business Name

MARK JAMES BLACK DDS

Original Issue Date

05/09/1994

Effective Date

09/19/2024

Expiration Date

09/30/2027

City

CHAMPAIGN

State

Zip

61821

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/19/2024