GREGORY MARSHALL RANDOLPH DDS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****52

License Status

ACTIVE

Business

First Name

GREGORY

Middle

MARSHALL

Last Name

RANDOLPH

Suffix

DDS

Business Name

GREGORY MARSHALL RANDOLPH DDS

Original Issue Date

07/24/1987

Effective Date

05/31/2024

Expiration Date

09/30/2027

City

BLOOMINGTON

State

Zip

61704

County

MCLEAN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/31/2024