License holder summary

Matthew Tae Park is a Controlled Substance Registration - Dentist licensed to practice in Indiana. The address on file for Matthew Tae Park is Park Family Dentistry, 1902 East Ireland Road, South Bend IN 46614. This licensed professional license is current. The license was granted 03/07/2005 and expired on 03/01/2016.

Indiana

Professional Licensing Agency

Matthew Tae Park
Controlled Substance Registration - Dentist
License number
12010713B
Date granted
03/07/2005
Date expires
03/01/2016
Class
Controlled Substance Registration - Dentist
Status
Active
Address
Park Family Dentistry, 1902 East Ireland Road, South Bend IN 46614
indianalicensing.org
ID 5123259
LAST UPDATED 2024-04-05 13:10:58 UTC

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