MADONNA JOAN WALLACE - Dentist License in Illinois | # 020002928

MADONNA JOAN WALLACE

Business Entity

NOT RENEWED

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020002928

License Status

NOT RENEWED

Business

N

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

State

IL

Ever Disciplined

N

LastModifiedDate

10/17/2005