JERRY LEO WILDE - Dentist License in Utah | # 019013775

JERRY LEO WILDE

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED DENTIST

License Number

019013775

License Status

INACTIVE

Business

N

First Name

JERRY LEO

Last Name

WILDE

Business Name

JERRY LEO WILDE

Original Issue Date

12/08/1969

Effective Date

12/08/1969

Expiration Date

09/30/1990

State

UT

Ever Disciplined

N

LastModifiedDate

10/12/2005