TERRENCE MARTIN WALL DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****58

License Status

NOT RENEWED

Business

First Name

TERRENCE

Middle

MARTIN

Last Name

WALL

Suffix

DDS

Business Name

TERRENCE MARTIN WALL DDS

Original Issue Date

01/01/1998

Effective Date

07/12/2012

Expiration Date

09/30/2015

City

PALOS HEIGHTS

State

Zip

60463

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016