JEFFREY RANDALL ROTH DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****02

License Status

NOT RENEWED

Business

First Name

JEFFREY RANDALL

Last Name

ROTH

Suffix

DMD

Business Name

JEFFREY RANDALL ROTH DMD

Original Issue Date

05/08/1992

Effective Date

05/08/1992

Expiration Date

09/30/2004

City

OLNEY

State

Zip

62450

County

RICHLAND

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

10/17/2005