BRADLEY A RANDOLPH DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****35

License Status

NOT RENEWED

Business

First Name

BRADLEY A

Last Name

RANDOLPH

Suffix

DDS

Business Name

BRADLEY A RANDOLPH DDS

Original Issue Date

03/19/1993

Effective Date

03/19/1993

Expiration Date

09/30/1996

City

BLOOMINGTON

State

Zip

61704

County

MCLEAN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005