GARY ALLAN HAGENS DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****96

License Status

NOT RENEWED

Business

First Name

GARY

Middle

ALLAN

Last Name

HAGENS

Suffix

DMD

Business Name

GARY ALLAN HAGENS DMD

Original Issue Date

10/02/1985

Effective Date

10/02/1985

Expiration Date

09/30/1994

City

MATTOON

State

Zip

61938

County

COLES

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005