CHAD MICHAEL WIESE DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****64

License Status

NOT RENEWED

Business

First Name

CHAD

Middle

MICHAEL

Last Name

WIESE

Suffix

DDS

Business Name

CHAD MICHAEL WIESE DDS

Original Issue Date

06/05/2007

Effective Date

09/17/2012

Expiration Date

09/30/2015

City

STERLING

State

Zip

61081

County

WHITESIDE

Specialty/Qualifier

HOSPITAL/CLINIC

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016