RODERICK SAMPSON COOPER Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****83

License Status

NOT RENEWED

Business

First Name

RODERICK

Middle

SAMPSON

Last Name

COOPER

Business Name

RODERICK SAMPSON COOPER

Original Issue Date

12/22/2009

Effective Date

12/22/2009

Expiration Date

09/30/2012

City

BELLEVILLE

State

Zip

62223

County

SAINT CLAIR

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012