DERRICK O FRYE Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****04

License Status

NOT RENEWED

Business

First Name

DERRICK O

Last Name

FRYE

Business Name

DERRICK O FRYE

Original Issue Date

03/06/1996

Effective Date

03/06/1996

Expiration Date

09/30/1996

City

ALTON

State

Zip

62002

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005