RUSSELL KENT WANGEN DMD Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED DENTIST

License Number

019015698

License Status

INACTIVE

Business

First Name

RUSSELL KENT

Last Name

WANGEN

Suffix

DMD

Business Name

RUSSELL KENT WANGEN DMD

Original Issue Date

09/20/1976

Effective Date

06/14/2018

Expiration Date

12/31/2021

City

PAWNEE

State

Zip

62558

County

SANGAMON

Ever Disciplined

LastModifiedDate

11/11/2021