JACK G WALZ DDS Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****08

License Status

CANCELLED

Business

First Name

JACK G

Last Name

WALZ

Suffix

DDS

Business Name

JACK G WALZ DDS

Original Issue Date

11/15/1991

Effective Date

11/15/1991

Expiration Date

09/30/1992

City

BLOOMINGTON

State

Zip

61701

County

MCLEAN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005