MARIALICE WAGNER Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020002595

License Status

ACTIVE

Business

First Name

MARIALICE

Last Name

WAGNER

Business Name

MARIALICE WAGNER

Original Issue Date

07/10/1975

Effective Date

06/19/2024

Expiration Date

09/30/2027

City

CHICAGO

State

Zip

60631

County

COOK

Ever Disciplined

LastModifiedDate

06/19/2024