WAYNE FRED WAGNER DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000042

License Status

NOT RENEWED

Business

First Name

WAYNE

Middle

FRED

Last Name

WAGNER

Suffix

DDS

Business Name

WAYNE FRED WAGNER DDS

Original Issue Date

01/01/1998

Effective Date

07/20/2009

Expiration Date

09/30/2012

City

HUNTLEY

State

Zip

60142

County

MCHENRY

Specialty/Qualifier

Deep Sedation and General Anesthesia

Ever Disciplined

LastModifiedDate

11/14/2012