Indiana
Professional Licensing Agency
Gordon Keith Green
Controlled Substance Registration - Dentist
License number
12007342B
Date granted
06/30/1986
Date expires
03/01/2016
Class
Controlled Substance Registration - Dentist
Status
Active
Address
P.O. Box 501, 147 East Broad Street, Lyons IN 47443-9502
indianalicensing.org
ID 5109484
LAST UPDATED 2024-02-12 21:46:52 UTC
LAST UPDATED 2024-02-12 21:46:52 UTC
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