LACY SUZANNE RUSSELL Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020011529

License Status

INACTIVE

Business

First Name

LACY

Middle

SUZANNE

Last Name

RUSSELL

Business Name

LACY SUZANNE RUSSELL

Original Issue Date

10/04/2005

Effective Date

06/04/2009

Expiration Date

09/30/2012

City

CHAMPAIGN

State

Zip

61821

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

06/06/2012