ANDREW TOD WIRTZ DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****58

License Status

NOT RENEWED

Business

Title

DMD

First Name

ANDREW

Middle

TOD

Last Name

WIRTZ

Business Name

ANDREW TOD WIRTZ DMD

Original Issue Date

07/25/2017

Effective Date

07/25/2017

Expiration Date

09/30/2018

City

ALTON

State

Zip

62002

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018