NANCY S WALLACE DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****22

License Status

NOT RENEWED

Business

First Name

NANCY S

Last Name

WALLACE

Suffix

DMD

Business Name

NANCY S WALLACE DMD

Original Issue Date

03/28/1996

Effective Date

09/17/2015

Expiration Date

09/30/2018

City

LAKE BLUFF

State

Zip

60044

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018