GARY ALLAN HAGENS DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000061

License Status

NOT RENEWED

Business

First Name

GARY

Middle

ALLAN

Last Name

HAGENS

Suffix

DMD

Business Name

GARY ALLAN HAGENS DMD

Original Issue Date

01/01/1998

Effective Date

09/28/2015

Expiration Date

09/30/2018

City

CHAMPAIGN

State

Zip

61822

County

CHAMPAIGN

Specialty/Qualifier

Deep Sedation and General Anesthesia

Ever Disciplined

LastModifiedDate

10/31/2018