MARK DOUGLAS MASE DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****97

License Status

NOT RENEWED

Business

First Name

MARK DOUGLAS

Last Name

MASE

Suffix

DDS

Business Name

MARK DOUGLAS MASE DDS

Original Issue Date

04/30/1984

Effective Date

07/24/2006

Expiration Date

09/30/2009

City

LOVES PARK

State

Zip

61111

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009