CAMERON J WAGNER DMD - Dentist License in Illinois | # 137000753

CAMERON J WAGNER DMD

Business Entity

INACTIVE

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000753

License Status

INACTIVE

Business

N

Title

DMD

First Name

CAMERON

Middle

J

Last Name

WAGNER

Business Name

CAMERON J WAGNER DMD

Original Issue Date

05/13/2009

Effective Date

07/05/2012

Expiration Date

09/30/2015

State

IL

Specialty/Qualifier

CONSCIOUS SEDATION, PARENTERAL

Ever Disciplined

N

LastModifiedDate

06/08/2015