WAYNERD B FREDERICKSON DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****05

License Status

NOT RENEWED

Business

First Name

WAYNERD

Middle

Last Name

FREDERICKSON

Suffix

DDS

Business Name

WAYNERD B FREDERICKSON DDS

Original Issue Date

06/15/2011

Effective Date

08/07/2015

Expiration Date

09/30/2018

City

GENEVA

State

Zip

60134

County

KANE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018