ROGER WALLACE DETTRO DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019011883

License Status

NOT RENEWED

Business

First Name

ROGER WALLACE

Last Name

DETTRO

Suffix

DDS

Business Name

ROGER WALLACE DETTRO DDS

Original Issue Date

07/31/1961

Effective Date

07/31/1961

Expiration Date

09/30/2002

City

MATTOON

State

Zip

61938

County

COLES

Ever Disciplined

LastModifiedDate

10/17/2005