ROBERT MARK BLAZEKOVICH Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****92

License Status

NOT RENEWED

Business

First Name

ROBERT MARK

Last Name

BLAZEKOVICH

Business Name

ROBERT MARK BLAZEKOVICH

Original Issue Date

08/16/1984

Effective Date

08/16/1984

Expiration Date

09/30/1996

City

CREST HILL

State

Zip

60435

County

WILL

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005