KLEYN BIRDWELL RUSSELL JR DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****81

License Status

NOT RENEWED

Business

First Name

KLEYN BIRDWELL

Last Name

RUSSELL JR

Suffix

DDS

Business Name

KLEYN BIRDWELL RUSSELL JR DDS

Original Issue Date

12/11/1990

Effective Date

12/11/1990

Expiration Date

09/30/1992

City

DECATUR

State

Zip

62526

County

MACON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005