MAX L WALLACE JR
Physician/surgeon


Address: 383 Rockwood Drive, Southington, CT 06489

MAX L WALLACE JR (Credential# 544520) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is September 1, 2017. The license expiration date date is August 31, 2018. The license status is INACTIVE.

Business Overview

MAX L WALLACE JR is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.023301. The credential type is physician/surgeon. The effective date is September 1, 2017. The expiration date is August 31, 2018. The business address is 383 Rockwood Drive, Southington, CT 06489. The current status is inactive.

Basic Information

Licensee Name MAX L WALLACE JR
Credential ID 544520
Credential Number 1.023301
Credential Type Physician/Surgeon
Business Address 383 Rockwood Drive
Southington
CT 06489
Business Type INDIVIDUAL
Status INACTIVE - LAPSED DUE TO NON-RENEWAL
Issue Date 1982-01-13
Effective Date 2017-09-01
Expiration Date 2018-08-31
Refresh Date 2018-12-04

Office Location

Street Address 383 Rockwood Drive
City Southington
State CT
Zip Code 06489

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Joanna Milewski 23 Stacy Cate Drive, Southington, CT 06489 Registered Nurse 2020-07-01 ~ 2021-06-30
Richard M Testa 81 Winter Park Road, Southington, CT 06489 Massage Therapist 2020-08-01 ~ 2022-07-31
Valley Roofing LLC 88 Ladyslipper Lane, Southington, CT 06489 Home Improvement Contractor ~
Dunkin Donuts · New England Donuts LLC 856 Queen St, Southington, CT 06489 Bakery 2020-07-01 ~ 2021-06-30
Elizabeth E Pizzuto 45 Water Street, Southington, CT 06489 Real Estate Salesperson 2020-06-18 ~ 2021-05-31
Nicholas C Ingel 515 West Street, Southington, CT 06489 Heating, Piping & Cooling Limited Journeyperson 2020-06-23 ~ 2021-08-31
Tyrone J Correa 84 Minthal Drive, Southington, CT 06489 Real Estate Salesperson 2020-06-19 ~ 2021-05-31
Marilyn F Coppola 114 Spring Hill Rd, Southington, CT 06489 Registered Nurse 2020-08-01 ~ 2021-07-31
Christine M Liebler 30 Sultana Terrace, Southington, CT 06489 Registered Nurse 2020-07-01 ~ 2021-06-30
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Competitor

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City Southington
Zip Code 06489
License Type Physician/Surgeon
License Type + County Physician/Surgeon + Southington

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Dataset Information

Data Provider Connecticut Department of Consumer Protection
Jurisdiction Connecticut
Related Datasets Connecticut Business Registrations, Connecticut Child Care Facilities

This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).

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