CAMERON MATTHEW RUSSELL Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****70

License Status

NOT RENEWED

Business

First Name

CAMERON

Middle

MATTHEW

Last Name

RUSSELL

Business Name

CAMERON MATTHEW RUSSELL

Original Issue Date

07/11/2002

Effective Date

07/11/2002

Expiration Date

09/30/2004

City

ALTON

State

Zip

62002

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005