JENNIFER M WALLER Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020017286

License Status

ACTIVE

Business

First Name

JENNIFER

Middle

Last Name

WALLER

Business Name

JENNIFER M WALLER

Original Issue Date

06/23/2021

Effective Date

09/19/2024

Expiration Date

09/30/2027

City

TISKILWA

State

Zip

61368

Ever Disciplined

LastModifiedDate

09/19/2024