MICHAEL P WALLACE DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****27

License Status

NOT RENEWED

Business

First Name

MICHAEL P

Last Name

WALLACE

Suffix

DMD

Business Name

MICHAEL P WALLACE DMD

Original Issue Date

09/12/1983

Effective Date

09/12/1983

Expiration Date

09/30/1984

City

EFFINGHAM

State

Zip

62401

County

EFFINGHAM

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005