SAMUEL MOORE WALLDEN DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST

License Number

019030757

License Status

ACTIVE

Business

Title

DMD

First Name

SAMUEL

Middle

MOORE

Last Name

WALLDEN

Business Name

SAMUEL MOORE WALLDEN DMD

Original Issue Date

06/23/2016

Effective Date

06/03/2024

Expiration Date

09/30/2027

City

ROCKFORD

State

Zip

61114

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

06/03/2024