JERRY LEO WILDE Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED DENTIST

License Number

019013775

License Status

INACTIVE

Business

First Name

JERRY LEO

Last Name

WILDE

Business Name

JERRY LEO WILDE

Original Issue Date

12/08/1969

Effective Date

12/08/1969

Expiration Date

09/30/1990

City

SALT LAKE CITY

State

Zip

84121

County

UTAH

Ever Disciplined

LastModifiedDate

10/12/2005