RUSSELL EDWARD WALTERS JR DDS Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED DENTIST

License Number

019013940

License Status

INACTIVE

Business

Title

DDS

First Name

RUSSELL

Middle

EDWARD

Last Name

WALTERS

Suffix

Business Name

RUSSELL EDWARD WALTERS JR DDS

Original Issue Date

07/07/1970

Effective Date

09/30/2004

Expiration Date

09/30/2006

City

DOWNERS GROVE

State

Zip

60516

County

DUPAGE

Ever Disciplined

LastModifiedDate

07/24/2006