KENYATTA MACK DDS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****23

License Status

ACTIVE

Business

Title

DDS

First Name

KENYATTA

Last Name

MACK

Business Name

KENYATTA MACK DDS

Original Issue Date

09/02/2020

Effective Date

09/20/2024

Expiration Date

09/30/2027

City

KING OF PRUSSIA

State

Zip

19406

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/20/2024