BRAD S BUCKINGHAM DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****39

License Status

NOT RENEWED

Business

First Name

BRAD

Middle

Last Name

BUCKINGHAM

Suffix

DMD

Business Name

BRAD S BUCKINGHAM DMD

Original Issue Date

04/25/2012

Effective Date

04/25/2012

Expiration Date

09/30/2012

City

MEMPHIS

State

Zip

38103

County

TENNESSEE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012