CHARLES JEROME WILTZ DDS Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED DENTIST

License Number

019013542

License Status

INACTIVE

Business

Title

DDS

First Name

CHARLES

Middle

JEROME

Last Name

WILTZ

Business Name

CHARLES JEROME WILTZ DDS

Original Issue Date

12/19/1968

Effective Date

06/16/2009

Expiration Date

09/30/2012

City

CHICAGO

State

Zip

60615

County

COOK

Ever Disciplined

LastModifiedDate

06/06/2012