WAYNE STANLEY GRISSOM Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED DENTIST

License Number

019007979

License Status

INACTIVE

Business

First Name

WAYNE STANLEY

Last Name

GRISSOM

Business Name

WAYNE STANLEY GRISSOM

Original Issue Date

07/30/1940

Effective Date

07/30/1940

Expiration Date

09/30/1992

City

DECATUR

State

Zip

62522

County

MACON

Ever Disciplined

LastModifiedDate

10/12/2005