WAYNE VAN SAUN GILLIAM Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****29

License Status

NOT RENEWED

Business

First Name

WAYNE VAN SAUN

Last Name

GILLIAM

Business Name

WAYNE VAN SAUN GILLIAM

Original Issue Date

01/01/1998

Expiration Date

09/30/1988

City

ROCK ISLAND

State

Zip

61201

County

ROCK ISLAND

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005