DOMINIK WIETRZYNSKI Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****09

License Status

NOT RENEWED

Business

First Name

DOMINIK

Last Name

WIETRZYNSKI

Business Name

DOMINIK WIETRZYNSKI

Original Issue Date

07/07/2010

Effective Date

07/07/2010

Expiration Date

09/30/2012

City

PEORIA

State

Zip

61614

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012