PHILIP EZRA CLARK DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****72

License Status

NOT RENEWED

Business

First Name

PHILIP EZRA

Last Name

CLARK

Suffix

DDS

Business Name

PHILIP EZRA CLARK DDS

Original Issue Date

01/01/1998

Effective Date

07/24/2006

Expiration Date

09/30/2009

City

QUINCY

State

Zip

62301

County

ADAMS

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

11/04/2009