NICHOLAS EDWARD BAKER DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****96

License Status

ACTIVE

Business

First Name

NICHOLAS

Middle

EDWARD

Last Name

BAKER

Suffix

DMD

Business Name

NICHOLAS EDWARD BAKER DMD

Original Issue Date

08/19/2015

Effective Date

05/06/2024

Expiration Date

09/30/2027

City

BLOOMINGTON

State

Zip

61704

County

MCLEAN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/06/2024