GERALD LEON WINE DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000257

License Status

NOT RENEWED

Business

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

City

CHICAGO

State

Zip

60622

County

COOK

Specialty/Qualifier

Conscious Sedation, Parenteral

Ever Disciplined

LastModifiedDate

11/14/2012