WALTER DONALD MADDOX Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****83

License Status

CANCELLED

Business

First Name

WALTER DONALD

Last Name

MADDOX

Business Name

WALTER DONALD MADDOX

Original Issue Date

08/23/2004

Effective Date

08/23/2004

Expiration Date

09/30/2006

City

DWIGHT

State

Zip

60420

County

LIVINGSTON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/24/2006