KEITH DOUGLASS RICE Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****39

License Status

NOT RENEWED

Business

First Name

KEITH

Middle

DOUGLASS

Last Name

RICE

Business Name

KEITH DOUGLASS RICE

Original Issue Date

06/18/2002

Effective Date

06/18/2002

Expiration Date

09/30/2004

City

EFFINGHAM

State

Zip

62401

County

EFFINGHAM

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005