WALLACE CARRILLO-MEDINA Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST

License Number

019034744

License Status

ACTIVE

Business

First Name

WALLACE

Last Name

CARRILLO-MEDINA

Business Name

WALLACE CARRILLO-MEDINA

Original Issue Date

12/28/2023

Effective Date

07/03/2024

Expiration Date

09/30/2027

City

CHICAGO

State

Zip

60607

County

COOK

Ever Disciplined

LastModifiedDate

07/03/2024