Utah
Division of Occupational and Professional Licensing
WAYNE ADDISON PROVOST
Dental - Dentist Anesthesia Class Ii Permit
License number
132912-9922
Date granted
01/01/1910
Date expires
05/31/1996
Class
Dental - Dentist Anesthesia Class Ii Permit
Status
Expired
Address
SALT LAKE CITY, UT 841090151
utahlicensing.org
ID 29719549
LAST UPDATED 2026-05-10 03:23:18 UTC
LAST UPDATED 2026-05-10 03:23:18 UTC
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