License holder summary

Lisa Marie Moore is a Controlled Substance Registration - Dentist licensed to practice in Indiana. The address on file for Lisa Marie Moore is 1005 East La Salle Avenue, South Bend IN 46617. This licensed professional license is current. The license was granted 06/04/1996 and expired on 03/01/2016.

Indiana

Professional Licensing Agency

Lisa Marie Moore
Controlled Substance Registration - Dentist
License number
12009706B
Date granted
06/04/1996
Date expires
03/01/2016
Class
Controlled Substance Registration - Dentist
Status
Active
Address
1005 East La Salle Avenue, South Bend IN 46617
indianalicensing.org
ID 5123201
LAST UPDATED 2026-06-10 02:52:41 UTC

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