Kelly Johanna Waggener
ActiveCalifornia license 48404
License
- Licensed by
- Dental Board of California
- License number
- 48404
- Status
- Active (Current)
- First issued
- April 16, 2003
- Expires
- April 30, 2027
- License holder
- Kelly Johanna Waggener
- Entity type
- Individual
Classifications
- Dental License Dental
More from the license record
- License type code
- 4401
Contact
80 Doctors Park Dr
Santa Rosa, CA 95405
Santa Rosa, CA 95405
Sonoma County