License holder summary

GLEN IVAN LAKE is a Controlled Substance Registration - Dentist licensed to practice in Indiana. The address on file for GLEN IVAN LAKE is 1235 PARK AVE, NEW HAVEN IN 46774. This licensed professional license is not current. The license was granted 07/05/1932 and expired on 05/31/1984.

Indiana

Professional Licensing Agency

GLEN IVAN LAKE
Controlled Substance Registration - Dentist
License number
12003919B
Date granted
07/05/1932
Date expires
05/31/1984
Class
Controlled Substance Registration - Dentist
Status
Expired
Address
1235 PARK AVE, NEW HAVEN IN 46774
indianalicensing.org
ID 5116022
LAST UPDATED 2024-02-27 06:01:01 UTC

This website is unaffiliated with the Professional Licensing Agency. Please verify all information directly with the relevant official government authority.

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