License holder summary

Amanda Marie Blackmon is a Controlled Substance Registration - Dentist licensed to practice in Indiana. The address on file for Amanda Marie Blackmon is Aspen Dental, 2124 East Bouleavard Street, Kokomo IN 46902. This licensed professional license is not current. The license was granted 08/11/2010 and expired on 03/01/2012.

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

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