JEFFREY RANDALL ROTH DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019022839

License Status

NOT RENEWED

Business

First Name

JEFFREY RANDALL

Last Name

ROTH

Suffix

DMD

Business Name

JEFFREY RANDALL ROTH DMD

Original Issue Date

04/03/1992

Effective Date

09/30/2004

Expiration Date

09/30/2006

City

OLNEY

State

Zip

62450

County

RICHLAND

Ever Disciplined

LastModifiedDate

01/31/2007