Indiana
Professional Licensing Agency
Connie Suah Shim Middleton
Controlled Substance Registration - Dentist
License number
12011842B
Date granted
06/26/2012
Date expires
03/01/2016
Class
Controlled Substance Registration - Dentist
Status
Active
Address
4302 E State Blvd, Fort Wayne IN 46815
indianalicensing.org
ID 5094350
LAST UPDATED 2024-02-11 15:04:13 UTC
LAST UPDATED 2024-02-11 15:04:13 UTC
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