KEVIN R WALLACE DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****13

License Status

ACTIVE

Business

First Name

KEVIN R

Last Name

WALLACE

Suffix

DMD

Business Name

KEVIN R WALLACE DMD

Original Issue Date

04/04/1991

Effective Date

07/17/2024

Expiration Date

09/30/2027

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/17/2024