Madonna Joan Wallace
ExpiredIllinois license 020002928
License
- Licensed by
- Illinois Department of Financial and Professional Regulation
- License number
- 020002928
- Status
- Expired (Not Renewed)
- First issued
- July 13, 1976
- Expired
- September 30, 2000
- License holder
- Madonna Joan Wallace
- Entity type
- Individual
Classifications
- Registered Dental Hygienist Dental
More from the license record
- Current term began
- 07/13/1976
Contact
Champaign, IL 61821
Champaign County