FONTAINE KEVELL WALKER DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****38

License Status

NOT RENEWED

Business

First Name

FONTAINE

Middle

KEVELL

Last Name

WALKER

Suffix

DDS

Business Name

FONTAINE KEVELL WALKER DDS

Original Issue Date

12/04/2002

Effective Date

12/04/2002

Expiration Date

09/30/2004

City

ROCK ISLAND

State

Zip

61201

County

ROCK ISLAND

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005