WALTER L DOMSALLA DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019005969

License Status

NOT RENEWED

Business

First Name

WALTER L

Last Name

DOMSALLA

Suffix

DDS

Business Name

WALTER L DOMSALLA DDS

Original Issue Date

12/17/1929

Effective Date

12/17/1929

City

FULTON

State

Zip

61252

County

WHITESIDE

Ever Disciplined

LastModifiedDate

10/12/2005