License holder summary

EMORY WALLACE BRYAN is a Controlled Substance Registration - Dentist licensed to practice in Indiana. The address on file for EMORY WALLACE BRYAN is 4618 EAST STATE BOULEVARD, FORT WAYNE IN 46815. This licensed professional license is not current. The license was granted 04/30/1986 and expired on 03/01/1990.

Indiana

Professional Licensing Agency

EMORY WALLACE BRYAN
Controlled Substance Registration - Dentist
License number
12004281B
Date granted
04/30/1986
Date expires
03/01/1990
Class
Controlled Substance Registration - Dentist
Status
Expired
Address
4618 EAST STATE BOULEVARD, FORT WAYNE IN 46815
indianalicensing.org
ID 5094635
LAST UPDATED 2024-04-18 07:38:08 UTC

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