Indiana
Professional Licensing Agency
Gerald A. Bieneman
Controlled Substance Registration - Dentist
License number
12009650B
Date granted
09/02/1994
Date expires
03/01/2002
Class
Controlled Substance Registration - Dentist
Status
Expired
Address
5201 GRAPE ROAD, MISHAWAKA IN 46545
indianalicensing.org
ID 5112451
LAST UPDATED 2024-03-22 18:45:40 UTC
LAST UPDATED 2024-03-22 18:45:40 UTC
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