ALLEN WAYNE WIESE DDS - Dentist License in Illinois | # 021000789

ALLEN WAYNE WIESE DDS

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED SPECIALIST IN DENTISTRY

License Number

021000789

License Status

NOT RENEWED

Business

N

First Name

ALLEN WAYNE

Last Name

WIESE

Suffix

DDS

Business Name

ALLEN WAYNE WIESE DDS

Original Issue Date

12/17/1973

Effective Date

12/17/1973

Expiration Date

09/30/1990

State

IL

Specialty/Qualifier

Orthodontics

Ever Disciplined

N

LastModifiedDate

10/13/2005