MARK T KIENLE Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****79

License Status

NOT RENEWED

Business

First Name

MARK T

Last Name

KIENLE

Business Name

MARK T KIENLE

Original Issue Date

09/03/1987

Effective Date

07/09/2018

Expiration Date

01/31/2022

City

ROCK ISLAND

State

Zip

61201

County

ROCK ISLAND

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022