RANDALL C REYES Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****93

License Status

NOT RENEWED

Business

First Name

RANDALL C

Last Name

REYES

Business Name

RANDALL C REYES

Original Issue Date

09/05/1990

Effective Date

09/05/1990

Expiration Date

09/30/1996

City

DECATUR

State

Zip

62522

County

MACON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005