Indiana
Professional Licensing Agency
Clarence Port Laderer
Controlled Substance Registration - Dentist
License number
12006396B
Date granted
05/31/1985
Date expires
03/01/2002
Class
Controlled Substance Registration - Dentist
Status
Expired
Address
614 SOUTH EDDY STREET, SOUTH BEND IN 46615
indianalicensing.org
ID 5122755
LAST UPDATED 2024-02-02 20:53:30 UTC
LAST UPDATED 2024-02-02 20:53:30 UTC
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