CAMERON J WAGNER DMD Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000753

License Status

INACTIVE

Business

Title

DMD

First Name

CAMERON

Middle

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

City

VERNON HILLS

State

Zip

60061

County

LAKE

Specialty/Qualifier

CONSCIOUS SEDATION, PARENTERAL

Ever Disciplined

LastModifiedDate

06/08/2015