MARK A MANGELS DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****68

License Status

NOT RENEWED

Business

First Name

MARK

Middle

Last Name

MANGELS

Suffix

DMD

Business Name

MARK A MANGELS DMD

Original Issue Date

09/27/2002

Effective Date

08/12/2009

Expiration Date

09/30/2012

City

SHILOH

State

Zip

62269

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012