GRANT CHRISTIAN RUSSELL DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****65

License Status

ACTIVE

Business

Title

DMD

First Name

GRANT

Middle

CHRISTIAN

Last Name

RUSSELL

Business Name

GRANT CHRISTIAN RUSSELL DMD

Original Issue Date

07/15/2023

Effective Date

08/27/2024

Expiration Date

09/30/2027

City

ALTON

State

Zip

62002

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/27/2024