CHARLES JEROME WILTZ DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****13

License Status

NOT RENEWED

Business

Title

DDS

First Name

CHARLES

Middle

JEROME

Last Name

WILTZ

Business Name

CHARLES JEROME WILTZ DDS

Original Issue Date

01/01/1998

Effective Date

06/16/2009

Expiration Date

09/30/2012

City

CHICAGO

State

Zip

60615

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012