RUSSELL KENT WANGEN DMD Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****48

License Status

INACTIVE

Business

First Name

RUSSELL KENT

Last Name

WANGEN

Suffix

DMD

Business Name

RUSSELL KENT WANGEN DMD

Original Issue Date

01/01/1998

Effective Date

06/14/2018

Expiration Date

12/31/2021

City

PAWNEE

State

Zip

62558

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/11/2021