DAVID PATRICK WICKNESS DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****33

License Status

NOT RENEWED

Business

First Name

DAVID

Middle

PATRICK

Last Name

WICKNESS

Suffix

DMD

Business Name

DAVID PATRICK WICKNESS DMD

Original Issue Date

08/27/2001

Effective Date

07/18/2012

Expiration Date

09/30/2015

City

CHAMPAIGN

State

Zip

61820

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016