NICHOLAS EDWARD BAKER DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****93

License Status

NOT RENEWED

Business

First Name

NICHOLAS

Middle

EDWARD

Last Name

BAKER

Suffix

DMD

Business Name

NICHOLAS EDWARD BAKER DMD

Original Issue Date

08/11/2008

Effective Date

06/29/2012

Expiration Date

09/30/2015

City

BLOOMINGTON

State

Zip

61701

County

MCLEAN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016