RICHARD PHILLIP LOGULLO Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****13

License Status

NOT RENEWED

Business

First Name

RICHARD PHILLIP

Last Name

LOGULLO

Business Name

RICHARD PHILLIP LOGULLO

Original Issue Date

01/01/1998

Effective Date

12/14/2015

Expiration Date

09/30/2018

City

CENTRALIA

State

Zip

62801

County

MARION

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018