DOUGLAS M WALLEN Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****37

License Status

ACTIVE

Business

First Name

DOUGLAS M

Last Name

WALLEN

Business Name

DOUGLAS M WALLEN

Original Issue Date

11/16/1987

Effective Date

06/26/2024

Expiration Date

09/30/2027

City

CHAMPAIGN

State

Zip

61821

County

CHAMPAIGN

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

06/26/2024