AMI BETH WAGNER Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020011832

License Status

NOT RENEWED

Business

First Name

AMI

Middle

BETH

Last Name

WAGNER

Business Name

AMI BETH WAGNER

Original Issue Date

07/25/2006

Effective Date

07/25/2006

Expiration Date

09/30/2009

City

CHICAGO

State

Zip

60614

County

COOK

Ever Disciplined

LastModifiedDate

11/04/2009