BRADLEY A RANDOLPH DDS - Dentist License in Illinois | # 018000648

BRADLEY A RANDOLPH DDS

Business Entity

NOT RENEWED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018000648

License Status

NOT RENEWED

Business

N

First Name

BRADLEY A

Last Name

RANDOLPH

Suffix

DDS

Business Name

BRADLEY A RANDOLPH DDS

Original Issue Date

07/16/1992

Effective Date

07/16/1992

Expiration Date

06/30/1993

State

IL

Specialty/Qualifier

General Practice Residency

Ever Disciplined

N

LastModifiedDate

10/12/2005