DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Gantenberg, Mallory Hope	DOIID	895770	NAIC NPN	17730725

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	10/16/2015	10/31/2016
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	11/3/2015	11/11/2016
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	10/20/2015	12/13/2016
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	10/20/2015	12/13/2016
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	1/5/2016	10/31/2016
Inactive	Humana Insurance Company	301104	Agent - Health	2/16/2016	10/31/2016

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Retiremed IQ, LLC	682484	Agent - Health	10/20/2015	12/19/2016