License holder summary

Michael Thomas Tom is a Controlled Substance Registration - Dentist licensed to practice in Indiana. The address on file for Michael Thomas Tom is 1135 West Dupont Road, Fort Wayne IN 46825. This licensed professional license is current. The license was granted 07/24/1998 and expired on 03/01/2016.

Indiana

Professional Licensing Agency

Michael Thomas Tom
Controlled Substance Registration - Dentist
License number
12010084B
Date granted
07/24/1998
Date expires
03/01/2016
Class
Controlled Substance Registration - Dentist
Status
Active
Address
1135 West Dupont Road, Fort Wayne IN 46825
indianalicensing.org
ID 5095479
LAST UPDATED 2024-04-27 22:47:44 UTC

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