MARK PETER ZMIYIWSKY DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****69

License Status

NOT RENEWED

Business

First Name

MARK

Middle

PETER

Last Name

ZMIYIWSKY

Suffix

DDS

Business Name

MARK PETER ZMIYIWSKY DDS

Original Issue Date

12/13/2005

Effective Date

09/24/2009

Expiration Date

09/30/2012

City

CHAMPAIGN

State

Zip

61822

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012