RANDOLPH KEN SHOUP Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019017786

License Status

NOT RENEWED

Business

First Name

RANDOLPH KEN

Last Name

SHOUP

Business Name

RANDOLPH KEN SHOUP

Original Issue Date

07/21/1981

Effective Date

07/21/1981

Expiration Date

09/30/1984

City

CAIRO

State

Zip

62914

County

ALEXANDER

Ever Disciplined

LastModifiedDate

10/12/2005