JEROLD COLLINS WILDE DDS - Dentist License in Illinois | # 018001051

JEROLD COLLINS WILDE DDS

Business Entity

NOT RENEWED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001051

License Status

NOT RENEWED

Business

N

First Name

JEROLD COLLINS

Last Name

WILDE

Suffix

DDS

Business Name

JEROLD COLLINS WILDE DDS

Original Issue Date

07/17/1997

Effective Date

07/17/1997

Expiration Date

06/30/1998

State

IL

Specialty/Qualifier

General Practice Residency

Ever Disciplined

N

LastModifiedDate

10/12/2005