MARK HENRY HABERMEYER Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****70

License Status

NOT RENEWED

Business

First Name

MARK

Middle

HENRY

Last Name

HABERMEYER

Business Name

MARK HENRY HABERMEYER

Original Issue Date

04/04/2019

Effective Date

04/04/2019

Expiration Date

01/31/2022

City

BLOOMINGTON

State

Zip

61704

County

MCLEAN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022