Indiana
Professional Licensing Agency
Amanda Marie Blackmon
Controlled Substance Registration - Dentist
License number
12011504B
Date granted
08/11/2010
Date expires
03/01/2012
Class
Controlled Substance Registration - Dentist
Status
Expired
Address
Aspen Dental, 2124 East Bouleavard Street, Kokomo IN 46902
indianalicensing.org
ID 5106140
LAST UPDATED 2024-01-25 19:23:11 UTC
LAST UPDATED 2024-01-25 19:23:11 UTC
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