RICKY KEN BIETHMAN DMD Dentist License verification

Business Entity

EXPIRED

License Type

Dentist

Description

RESTRICTED FACULTY LICENSE

License Number

136000156

License Status

EXPIRED

Business

First Name

RICKY

Middle

KEN

Last Name

BIETHMAN

Suffix

DMD

Business Name

RICKY KEN BIETHMAN DMD

Original Issue Date

08/17/2010

Effective Date

06/25/2019

Expiration Date

06/30/2022

City

ALTON

State

Zip

62002

County

MADISON

Ever Disciplined

LastModifiedDate

11/28/2022