KRYSTIN L WAGNER Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020011624

License Status

NOT RENEWED

Business

First Name

KRYSTIN

Middle

Last Name

WAGNER

Business Name

KRYSTIN L WAGNER

Original Issue Date

03/22/2006

Effective Date

10/01/2006

Expiration Date

09/30/2009

City

PLAINFIELD

State

Zip

60544

County

WILL

Ever Disciplined

LastModifiedDate

11/04/2009