RICHARD DUANE FORD DDS Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****39

License Status

CANCELLED

Business

First Name

RICHARD DUANE

Last Name

FORD

Suffix

DDS

Business Name

RICHARD DUANE FORD DDS

Original Issue Date

01/01/1998

Expiration Date

09/30/2004

City

DECATUR

State

Zip

62522

County

MACON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005