Indiana
Professional Licensing Agency
Jeffrey Thomas Beacham
Controlled Substance Registration - Dentist
License number
12011662B
Date granted
06/17/2011
Date expires
03/01/2016
Class
Controlled Substance Registration - Dentist
Status
Active
Address
AFDENT, 4041 Parnell Avenue, Fort Wayne IN 46805
indianalicensing.org
ID 5095060
LAST UPDATED 2024-01-19 18:10:27 UTC
LAST UPDATED 2024-01-19 18:10:27 UTC
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