WALTER KELLEY FARRIS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****23

License Status

NOT RENEWED

Business

First Name

WALTER

Middle

KELLEY

Last Name

FARRIS

Business Name

WALTER KELLEY FARRIS

Original Issue Date

06/17/2019

Effective Date

06/17/2019

Expiration Date

01/31/2022

City

WOODSTOCK

State

Zip

60098

County

MCHENRY

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022