MARY M WIELGUS DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****93

License Status

NOT RENEWED

Business

First Name

MARY

Middle

Last Name

WIELGUS

Suffix

DDS

Business Name

MARY M WIELGUS DDS

Original Issue Date

05/14/2010

Effective Date

05/14/2010

Expiration Date

09/30/2012

City

PULASKI

State

Zip

54162

County

WISCONSIN

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

11/14/2012