STEPHANIE LYNN WAGNER DDS Dentist License verification

Business Entity

EXPIRED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001520

License Status

EXPIRED

Business

First Name

STEPHANIE

Middle

LYNN

Last Name

WAGNER

Suffix

DDS

Business Name

STEPHANIE LYNN WAGNER DDS

Original Issue Date

09/30/2004

Effective Date

09/30/2004

Expiration Date

06/30/2005

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

General Practice Residency

Ever Disciplined

LastModifiedDate

10/12/2005