DAVID F WAGNER Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****88

License Status

NOT RENEWED

Business

First Name

DAVID F

Last Name

WAGNER

Business Name

DAVID F WAGNER

Original Issue Date

12/04/1987

Effective Date

12/04/1987

Expiration Date

09/30/1988

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005