JUSTIN LOUIS RIDER DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****11

License Status

NOT RENEWED

Business

Title

DDS

First Name

JUSTIN

Middle

LOUIS

Last Name

RIDER

Business Name

JUSTIN LOUIS RIDER DDS

Original Issue Date

05/15/2009

Effective Date

05/15/2009

Expiration Date

09/30/2009

City

KEWANEE

State

Zip

61443

County

HENRY

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009