DERRIK LANCE RICHARD DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****72

License Status

NOT RENEWED

Business

First Name

DERRIK

Middle

LANCE

Last Name

RICHARD

Suffix

DMD

Business Name

DERRIK LANCE RICHARD DMD

Original Issue Date

10/16/1998

Effective Date

10/01/2018

Expiration Date

01/31/2022

City

EDWARDSVILLE

State

Zip

62025

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022