KELLIE BREANNE WAGNER Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020012861

License Status

NOT RENEWED

Business

First Name

KELLIE

Middle

BREANNE

Last Name

WAGNER

Business Name

KELLIE BREANNE WAGNER

Original Issue Date

06/17/2009

Effective Date

08/14/2012

Expiration Date

09/30/2015

City

CHICAGO

State

Zip

60614

County

COOK

Ever Disciplined

LastModifiedDate

04/25/2016