WALTER DONALD MADDOX Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000235

License Status

INACTIVE

Business

First Name

WALTER DONALD

Last Name

MADDOX

Business Name

WALTER DONALD MADDOX

Original Issue Date

02/15/1990

Effective Date

02/15/1990

Expiration Date

09/30/1996

City

KANKAKEE

State

Zip

60901

County

KANKAKEE

Specialty/Qualifier

Conscious Sedation, Parenteral

Ever Disciplined

LastModifiedDate

10/13/2005