RUSSELL EDWARD KLEIN DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****74

License Status

NOT RENEWED

Business

First Name

RUSSELL EDWARD

Last Name

KLEIN

Suffix

DMD

Business Name

RUSSELL EDWARD KLEIN DMD

Original Issue Date

01/01/1998

Effective Date

06/17/2015

Expiration Date

09/30/2018

City

CARBONDALE

State

Zip

62901

County

JACKSON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018