RICHARD MARK PORT DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****82

License Status

NOT RENEWED

Business

First Name

RICHARD MARK

Last Name

PORT

Suffix

DDS

Business Name

RICHARD MARK PORT DDS

Original Issue Date

11/07/1988

Effective Date

11/07/1988

Expiration Date

09/30/1992

City

LAKE VILLA

State

Zip

60046

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005