WALLACE DALE LONG Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019010871

License Status

NOT RENEWED

Business

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

City

DECATUR

State

Zip

62523

County

MACON

Ever Disciplined

LastModifiedDate

10/12/2005