RAPHAEL PRINCE RICARD DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****73

License Status

NOT RENEWED

Business

First Name

RAPHAEL

Middle

PRINCE

Last Name

RICARD

Suffix

DDS

Business Name

RAPHAEL PRINCE RICARD DDS

Original Issue Date

08/18/2004

Effective Date

08/18/2004

Expiration Date

09/30/2006

City

SO CHICAGO HEIGHTS

State

Zip

60411

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/08/2007