RUSSELL EDWARD WALTERS JR DDS - Dentist License in Illinois | # 019013940

RUSSELL EDWARD WALTERS JR DDS

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED DENTIST

License Number

019013940

License Status

INACTIVE

Business

N

Title

DDS

First Name

RUSSELL

Middle

EDWARD

Last Name

WALTERS

Suffix

JR

Business Name

RUSSELL EDWARD WALTERS JR DDS

Original Issue Date

07/07/1970

Effective Date

09/30/2004

Expiration Date

09/30/2006

State

IL

Ever Disciplined

N

LastModifiedDate

07/24/2006