Indiana
Professional Licensing Agency
Jennifer L. Roberts
Controlled Substance Registration - Dentist
License number
12010690B
Date granted
08/08/2005
Date expires
03/01/2016
Class
Controlled Substance Registration - Dentist
Status
Active
Address
South Bend Family Dental, 1605 N. Ironwood, South Bend IN 46635
indianalicensing.org
ID 5123054
LAST UPDATED 2026-04-08 21:47:28 UTC
LAST UPDATED 2026-04-08 21:47:28 UTC
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