RUSSELL EDWARD KLEIN DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****75

License Status

NOT RENEWED

Business

First Name

RUSSELL EDWARD

Last Name

KLEIN

Suffix

DMD

Business Name

RUSSELL EDWARD KLEIN DMD

Original Issue Date

02/22/1982

Effective Date

02/22/1982

Expiration Date

09/30/1984

City

ALTON

State

Zip

62002

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005