ALLEN WAYNE WIESE DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED SPECIALIST IN DENTISTRY

License Number

021000789

License Status

NOT RENEWED

Business

First Name

ALLEN WAYNE

Last Name

WIESE

Suffix

DDS

Business Name

ALLEN WAYNE WIESE DDS

Original Issue Date

12/17/1973

Effective Date

12/17/1973

Expiration Date

09/30/1990

City

LASALLE

State

Zip

61301

County

LA SALLE

Specialty/Qualifier

Orthodontics

Ever Disciplined

LastModifiedDate

10/13/2005