GERALD LEON WINE DDS - Dentist License in Illinois | # 137000257

GERALD LEON WINE DDS

Business Entity

NOT RENEWED

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000257

License Status

NOT RENEWED

Business

N

First Name

GERALD LEON

Last Name

WINE

Suffix

DDS

Business Name

GERALD LEON WINE DDS

Original Issue Date

06/20/1990

Effective Date

06/04/2009

Expiration Date

09/30/2012

State

IL

Specialty/Qualifier

Conscious Sedation, Parenteral

Ever Disciplined

N

LastModifiedDate

11/14/2012