KEITH P WILSON DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****90

License Status

NOT RENEWED

Business

First Name

KEITH

Middle

Last Name

WILSON

Suffix

DDS

Business Name

KEITH P WILSON DDS

Original Issue Date

09/29/2000

Effective Date

09/29/2000

Expiration Date

09/30/2004

City

PEOTONE

State

Zip

60468

County

WILL

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005