WAYNE JAMES FITZPATRICK DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****16

License Status

NOT RENEWED

Business

First Name

WAYNE

Middle

JAMES

Last Name

FITZPATRICK

Suffix

DDS

Business Name

WAYNE JAMES FITZPATRICK DDS

Original Issue Date

01/01/1998

Expiration Date

09/30/1998

City

PEORIA

State

Zip

61604

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005