CHARLES JOHN WAGENER DDS MS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****07

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

12/11/1990

Effective Date

09/29/2015

Expiration Date

09/30/2018

City

LOVES PARK

State

Zip

61111

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018