REGINALD LAMAR FULFORD DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****98

License Status

NOT RENEWED

Business

First Name

REGINALD

Middle

LAMAR

Last Name

FULFORD

Suffix

DDS

Business Name

REGINALD LAMAR FULFORD DDS

Original Issue Date

02/14/2000

Effective Date

02/14/2000

Expiration Date

09/30/2004

City

CICERO

State

Zip

60804

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005