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 2024-04-01 00:46:49 UTC
LAST UPDATED 2024-04-01 00:46:49 UTC
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