WALLACE DALE LONG - Dentist License in Illinois | # 019010871

WALLACE DALE LONG

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019010871

License Status

NOT RENEWED

Business

N

First Name

WALLACE DALE

Last Name

LONG

Business Name

WALLACE DALE LONG

Original Issue Date

08/14/1956

Effective Date

08/14/1956

Expiration Date

09/30/1994

State

IL

Ever Disciplined

N

LastModifiedDate

10/12/2005