License holder summary

Michael Louis Iczkovitz is a Controlled Substance Registration - Dentist licensed to practice in Indiana. The address on file for Michael Louis Iczkovitz is Midwest Oral & Maxillofacial Surgery, 516 North Line Street, Columbia City IN 46725-1230. This licensed professional license is current. The license was granted 06/29/2000 and expired on 03/01/2016.

Indiana

Professional Licensing Agency

Michael Louis Iczkovitz
Controlled Substance Registration - Dentist
License number
12008664C
Date granted
06/29/2000
Date expires
03/01/2016
Class
Controlled Substance Registration - Dentist
Status
Active
Address
Midwest Oral & Maxillofacial Surgery, 516 North Line Street, Columbia City IN 46725-1230
indianalicensing.org
ID 22437760
LAST UPDATED 2021-01-23 19:47:58 UTC

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