MADONNA JOAN WALLACE Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020002928

License Status

NOT RENEWED

Business

First Name

MADONNA JOAN

Last Name

WALLACE

Business Name

MADONNA JOAN WALLACE

Original Issue Date

07/13/1976

Effective Date

07/13/1976

Expiration Date

09/30/2000

City

CHAMPAIGN

State

Zip

61821

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

10/17/2005