Indiana
Professional Licensing Agency
Michael S. Gideon
Controlled Substance Registration - Dentist
License number
12010673B
Date granted
07/20/2004
Date expires
03/01/2016
Class
Controlled Substance Registration - Dentist
Status
Active
Address
275 U.S. Rte 30, Ste #200, Dyer IN 46311
indianalicensing.org
ID 5090158
LAST UPDATED 2024-04-17 06:33:26 UTC
LAST UPDATED 2024-04-17 06:33:26 UTC
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