RICHARD KEITH USEDOM Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****06

License Status

ACTIVE

Business

First Name

RICHARD KEITH

Last Name

USEDOM

Business Name

RICHARD KEITH USEDOM

Original Issue Date

12/09/1982

Effective Date

08/02/2024

Expiration Date

09/30/2027

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/02/2024