JEROLD COLLINS WILDE DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****69

License Status

NOT RENEWED

Business

First Name

JEROLD COLLINS

Last Name

WILDE

Suffix

DDS

Business Name

JEROLD COLLINS WILDE DDS

Original Issue Date

11/25/1997

Effective Date

11/25/1997

Expiration Date

09/30/1998

City

CHICAGO

State

Zip

60640

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005