RANDAL W JOHNSON DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****80

License Status

NOT RENEWED

Business

First Name

RANDAL W

Last Name

JOHNSON

Suffix

DMD

Business Name

RANDAL W JOHNSON DMD

Original Issue Date

12/16/1993

Effective Date

07/13/2015

Expiration Date

09/30/2018

City

SPARTA

State

Zip

62286

County

RANDOLPH

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018