KLEYN BIRDWELL RUSSELL JR DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019016923

License Status

NOT RENEWED

Business

First Name

KLEYN BIRDWELL

Last Name

RUSSELL JR

Suffix

DDS

Business Name

KLEYN BIRDWELL RUSSELL JR DDS

Original Issue Date

08/14/1979

Effective Date

08/14/1979

Expiration Date

09/30/1992

City

ORMOND BEACH

State

Zip

32175

County

FLORIDA

Ever Disciplined

LastModifiedDate

10/12/2005

Case Number

1992003150

Action

Suspension

Discipline Start Date

12/28/1993

Discipline Reason

Disciplined in Oklahoma and Florida.