BRADLEY A RANDOLPH DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018000648

License Status

NOT RENEWED

Business

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

City

EVANSTON

State

Zip

60201

County

COOK

Specialty/Qualifier

General Practice Residency

Ever Disciplined

LastModifiedDate

10/12/2005