WAYNE FRED WAGNER DDS - Dentist License in Illinois | # 019014427

WAYNE FRED WAGNER DDS

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED DENTIST

License Number

019014427

License Status

INACTIVE

Business

N

First Name

WAYNE

Middle

FRED

Last Name

WAGNER

Suffix

DDS

Business Name

WAYNE FRED WAGNER DDS

Original Issue Date

07/12/1972

Effective Date

07/20/2009

Expiration Date

09/30/2012

State

IL

Ever Disciplined

N

LastModifiedDate

06/06/2012