CAMERON J WAGNER DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****84

License Status

NOT RENEWED

Business

Title

DMD

First Name

CAMERON

Middle

Last Name

WAGNER

Business Name

CAMERON J WAGNER DMD

Original Issue Date

06/12/2006

Effective Date

07/05/2012

Expiration Date

09/30/2015

City

VERNON HILLS

State

Zip

60061

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016