License holder summary

Dustin Shane Clevidence is a Controlled Substance Registration - Dentist licensed to practice in Indiana. The address on file for Dustin Shane Clevidence is Kool Smiles, 400 East Diamond Avenue, Evansville IN 47711. This licensed professional license is current. The license was granted 05/29/2013 and expired on 03/01/2016.

Indiana

Professional Licensing Agency

Dustin Shane Clevidence
Controlled Substance Registration - Dentist
License number
12011963B
Date granted
05/29/2013
Date expires
03/01/2016
Class
Controlled Substance Registration - Dentist
Status
Active
Address
Kool Smiles, 400 East Diamond Avenue, Evansville IN 47711
indianalicensing.org
ID 5091839
LAST UPDATED 2024-04-25 00:41:07 UTC

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