MARA K GANIM DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****99

License Status

ACTIVE

Business

Title

DMD

First Name

MARA

Middle

Last Name

GANIM

Business Name

MARA K GANIM DMD

Original Issue Date

11/05/2021

Effective Date

09/09/2024

Expiration Date

09/30/2027

City

O FALLON

State

Zip

62269

County

SAINT CLAIR

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/09/2024