LACEDRIC REITRICH TOLLIVER Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****91

License Status

ACTIVE

Business

First Name

LACEDRIC

Middle

REITRICH

Last Name

TOLLIVER

Business Name

LACEDRIC REITRICH TOLLIVER

Original Issue Date

11/15/2022

Effective Date

08/17/2024

Expiration Date

09/30/2027

City

SOUTH HOLLAND

State

Zip

60473

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/17/2024