KEITH P WILSON DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001068

License Status

NOT RENEWED

Business

First Name

KEITH

Middle

Last Name

WILSON

Suffix

DDS

Business Name

KEITH P WILSON DDS

Original Issue Date

08/14/1997

Effective Date

08/14/1997

Expiration Date

06/30/1998

City

CHICAGO

State

Zip

60616

County

COOK

Specialty/Qualifier

General Practice Residency

Ever Disciplined

LastModifiedDate

10/12/2005