ROBERT MARK BLAZEKOVICH Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019019051

License Status

NOT RENEWED

Business

First Name

ROBERT MARK

Last Name

BLAZEKOVICH

Business Name

ROBERT MARK BLAZEKOVICH

Original Issue Date

07/25/1984

Effective Date

07/25/1984

Expiration Date

09/30/1996

City

MARION

State

Zip

46952

County

INDIANA

Ever Disciplined

LastModifiedDate

10/12/2005