CHARLES JOHN WAGENER DDS MS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000448

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

12/01/1998

Effective Date

09/20/2012

Expiration Date

09/30/2015

City

LOVES PARK

State

Zip

61111

County

WINNEBAGO

Specialty/Qualifier

CONSCIOUS SEDATION, PARENTERAL

Ever Disciplined

LastModifiedDate

02/08/2016