SHANNON DANIELLE WALL DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****37

License Status

NOT RENEWED

Business

Title

DMD

First Name

SHANNON

Middle

DANIELLE

Last Name

WALL

Business Name

SHANNON DANIELLE WALL DMD

Original Issue Date

09/23/2021

Effective Date

09/23/2021

Expiration Date

09/30/2024

City

SAINT LOUIS

State

Zip

63118

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025