WILLIAM C WAGNER Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****02

License Status

NOT RENEWED

Business

First Name

WILLIAM C

Last Name

WAGNER

Business Name

WILLIAM C WAGNER

Original Issue Date

06/18/2007

Effective Date

08/21/2012

Expiration Date

09/30/2015

City

BLOOMINGTON

State

Zip

61701

County

MCLEAN

Specialty/Qualifier

HOSPITAL/CLINIC

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016