Indiana
Professional Licensing Agency
Koushan Haidarzadeh Azad
Controlled Substance Registration - Dentist
License number
12011918B
Date granted
03/13/2013
Date expires
03/01/2016
Class
Controlled Substance Registration - Dentist
Status
Active
Address
Familia Dental, 5328 Coldwater Road, Fort Wayne IN 46825
indianalicensing.org
ID 5095211
LAST UPDATED 2024-04-25 08:28:53 UTC
LAST UPDATED 2024-04-25 08:28:53 UTC
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