STEPHEN A WALLACE DDS 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

STEPHEN A

Last Name

WALLACE

Suffix

DDS

Business Name

STEPHEN A WALLACE DDS

Original Issue Date

09/26/1988

Effective Date

07/05/2018

Expiration Date

01/31/2022

City

LAGRANGE

State

Zip

60525

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022