MICHAEL P WALLACE DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019018736

License Status

NOT RENEWED

Business

First Name

MICHAEL P

Last Name

WALLACE

Suffix

DMD

Business Name

MICHAEL P WALLACE DMD

Original Issue Date

08/02/1983

Effective Date

08/02/1983

Expiration Date

09/30/2000

City

RICHMOND HEIGHTS

State

Zip

63117

County

MISSOURI

Ever Disciplined

LastModifiedDate

10/17/2005