MARK A STEPHENS DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****78

License Status

NOT RENEWED

Business

Title

DMD

First Name

MARK

Middle

Last Name

STEPHENS

Business Name

MARK A STEPHENS DMD

Original Issue Date

01/30/2018

Effective Date

10/19/2021

Expiration Date

09/30/2024

City

LITCHFIELD

State

Zip

62056

County

MONTGOMERY

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025