SHANNON DANIELLE WALL DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST

License Number

019033169

License Status

ACTIVE

Business

Title

DMD

First Name

SHANNON

Middle

DANIELLE

Last Name

WALL

Business Name

SHANNON DANIELLE WALL DMD

Original Issue Date

06/09/2021

Effective Date

05/18/2024

Expiration Date

09/30/2027

City

SAINT LOUIS

State

Zip

63118

Ever Disciplined

LastModifiedDate

05/18/2024