RICHARD MICHAEL DZIAK DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****01

License Status

NOT RENEWED

Business

First Name

RICHARD MICHAEL

Last Name

DZIAK

Suffix

DDS

Business Name

RICHARD MICHAEL DZIAK DDS

Original Issue Date

12/24/1997

Effective Date

07/24/2006

Expiration Date

09/30/2009

City

LONG BEACH

State

Zip

46360

County

INDIANA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009