Indiana
Professional Licensing Agency
John LeGlagen Hall
Controlled Substance Registration - Dentist
License number
12011912B
Date granted
02/06/2013
Date expires
03/01/2016
Class
Controlled Substance Registration - Dentist
Status
Active
Address
605 Douglass Rd, Mishawaka IN 46545
indianalicensing.org
ID 5112546
LAST UPDATED 2024-02-17 11:33:52 UTC
LAST UPDATED 2024-02-17 11:33:52 UTC
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