ROGER WALLACE DETTRO DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****61

License Status

NOT RENEWED

Business

First Name

ROGER WALLACE

Last Name

DETTRO

Suffix

DDS

Business Name

ROGER WALLACE DETTRO DDS

Original Issue Date

01/01/1998

Expiration Date

09/30/2002

City

MATTOON

State

Zip

61938

County

COLES

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005