License holder summary

Nick James Lebanoff is a Controlled Substance Registration - Dentist licensed to practice in Indiana. The address on file for Nick James Lebanoff is 3528 SOUTH CALHOUN, FORT WAYNE IN 46807. This licensed professional license is not current. The license was granted 05/31/1986 and expired on 03/01/2000.

Indiana

Professional Licensing Agency

Nick James Lebanoff
Controlled Substance Registration - Dentist
License number
12005925B
Date granted
05/31/1986
Date expires
03/01/2000
Class
Controlled Substance Registration - Dentist
Status
Expired
Address
3528 SOUTH CALHOUN, FORT WAYNE IN 46807
indianalicensing.org
ID 5095527
LAST UPDATED 2024-04-26 23:24:08 UTC

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