ERICA SUE WALDAU DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****65

License Status

NOT RENEWED

Business

First Name

ERICA

Middle

SUE

Last Name

WALDAU

Suffix

DMD

Business Name

ERICA SUE WALDAU DMD

Original Issue Date

06/22/2005

Effective Date

06/22/2005

Expiration Date

09/30/2006

City

ALTON

State

Zip

62002

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/08/2006