WAYNE FRED WAGNER DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****57

License Status

NOT RENEWED

Business

First Name

WAYNE

Middle

FRED

Last Name

WAGNER

Suffix

DDS

Business Name

WAYNE FRED WAGNER DDS

Original Issue Date

01/01/1998

Effective Date

07/20/2009

Expiration Date

09/30/2012

City

HUNTLEY

State

Zip

60142

County

MCHENRY

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012