RUSSELL EDWARD WALTERS JR DDS Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****69

License Status

CANCELLED

Business

Title

DDS

First Name

RUSSELL

Middle

EDWARD

Last Name

WALTERS

Suffix

Business Name

RUSSELL EDWARD WALTERS JR DDS

Original Issue Date

01/01/1998

Expiration Date

09/30/2006

City

DOWNERS GROVE

State

Zip

60516

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/24/2006