SAMUEL MOORE WALLDEN DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****61

License Status

ACTIVE

Business

Title

DMD

First Name

SAMUEL

Middle

MOORE

Last Name

WALLDEN

Business Name

SAMUEL MOORE WALLDEN DMD

Original Issue Date

06/23/2016

Effective Date

06/03/2024

Expiration Date

09/30/2027

City

ROCKFORD

State

Zip

61114

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/03/2024