RANDOLPH MACON RICHARDSON IV DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****31

License Status

NOT RENEWED

Business

First Name

RANDOLPH MACON

Last Name

RICHARDSON IV

Suffix

DMD

Business Name

RANDOLPH MACON RICHARDSON IV DMD

Original Issue Date

08/31/1984

Effective Date

08/31/1984

Expiration Date

09/30/1986

City

EVANSTON

State

Zip

60201

County

COOK

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

10/13/2005