WALTER LOUIS LEEKS III 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

Title

DMD

First Name

WALTER

Middle

LOUIS

Last Name

LEEKS

Suffix

III

Business Name

WALTER LOUIS LEEKS III DMD

Original Issue Date

03/18/2013

Effective Date

03/18/2013

Expiration Date

09/30/2015

City

MATTOON

State

Zip

61938

County

COLES

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016