RUSSELL F BLACK Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019004033

License Status

NOT RENEWED

Business

First Name

RUSSELL F

Last Name

BLACK

Business Name

RUSSELL F BLACK

Original Issue Date

01/01/1998

City

BEARDSTOWN

State

Zip

62618

County

CASS

Ever Disciplined

LastModifiedDate

10/12/2005