DOUGLAS W WALLACE DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019017806

License Status

NOT RENEWED

Business

First Name

DOUGLAS W

Last Name

WALLACE

Suffix

DDS

Business Name

DOUGLAS W WALLACE DDS

Original Issue Date

07/30/1981

Effective Date

07/30/1981

Expiration Date

09/30/1984

City

FOREST PARK

State

Zip

60130

County

COOK

Ever Disciplined

LastModifiedDate

10/12/2005