PETER LOUIS WAGNER DDS Dentist License verification

Business Entity

EXPIRED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001473

License Status

EXPIRED

Business

First Name

PETER

Middle

LOUIS

Last Name

WAGNER

Suffix

DDS

Business Name

PETER LOUIS WAGNER DDS

Original Issue Date

07/08/2004

Effective Date

07/08/2004

Expiration Date

06/30/2008

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Oral and Maxillofacial Surgery

Ever Disciplined

LastModifiedDate

07/31/2008