KYLE BLAKE HAGEN DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****77

License Status

ACTIVE

Business

First Name

KYLE BLAKE

Last Name

HAGEN

Suffix

DMD

Business Name

KYLE BLAKE HAGEN DMD

Original Issue Date

08/06/1996

Effective Date

05/01/2024

Expiration Date

09/30/2027

City

EAST ALTON

State

Zip

62024

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/01/2024