CHARLES JOHN WAGENER DDS MS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED SPECIALIST IN DENTISTRY

License Number

021001534

License Status

NOT RENEWED

Business

Title

DDS MS

First Name

CHARLES

Middle

JOHN

Last Name

WAGENER

Business Name

CHARLES JOHN WAGENER DDS MS

Original Issue Date

01/04/1991

Effective Date

09/29/2015

Expiration Date

09/30/2018

City

LOVES PARK

State

Zip

61111

County

WINNEBAGO

Specialty/Qualifier

PERIODONTICS

Ever Disciplined

LastModifiedDate

10/31/2018