DERRIK LANCE RICHARD DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****22

License Status

NOT RENEWED

Business

First Name

DERRIK

Middle

LANCE

Last Name

RICHARD

Suffix

DMD

Business Name

DERRIK LANCE RICHARD DMD

Original Issue Date

01/31/2022

Effective Date

01/31/2022

Expiration Date

09/30/2024

City

EDWARDSVILLE

State

Zip

62025

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025