Indiana
Professional Licensing Agency
Ken J. Roller
Controlled Substance Registration - Dentist
License number
12006641B
Date granted
08/31/1986
Date expires
03/01/2004
Class
Controlled Substance Registration - Dentist
Status
Expired
Address
4656 WEST JEFFERSON BLVD, FORT WAYNE IN 46804
indianalicensing.org
ID 5095199
LAST UPDATED 2024-04-20 04:19:12 UTC
LAST UPDATED 2024-04-20 04:19:12 UTC
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