WAYNE FRED WAGNER DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****32

License Status

NOT RENEWED

Business

First Name

WAYNE

Middle

FRED

Last Name

WAGNER

Suffix

DDS

Business Name

WAYNE FRED WAGNER DDS

Original Issue Date

10/24/2000

Effective Date

07/23/2009

Expiration Date

09/30/2012

City

WORTH

State

Zip

60482

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012