MIA MICHELLE RANDOLPH Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020009894

License Status

NOT RENEWED

Business

First Name

MIA

Middle

MICHELLE

Last Name

RANDOLPH

Business Name

MIA MICHELLE RANDOLPH

Original Issue Date

08/16/2000

Effective Date

08/16/2000

Expiration Date

09/30/2002

City

BLOOMINGTON

State

Zip

61704

County

MCLEAN

Ever Disciplined

LastModifiedDate

10/17/2005