KEVIN R WALLACE DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST

License Number

019022339

License Status

ACTIVE

Business

First Name

KEVIN R

Last Name

WALLACE

Suffix

DMD

Business Name

KEVIN R WALLACE DMD

Original Issue Date

12/08/1990

Effective Date

07/17/2024

Expiration Date

09/30/2027

City

ELMWOOD PARK

State

Zip

60707

County

COOK

Ever Disciplined

LastModifiedDate

07/17/2024