WAYNE FRED WAGNER DDS Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED DENTIST

License Number

019014427

License Status

INACTIVE

Business

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

City

HUNTLEY

State

Zip

60142

County

MCHENRY

Ever Disciplined

LastModifiedDate

06/06/2012