Indiana
Professional Licensing Agency
Patrick Keone Miyamasu
Controlled Substance Registration - Dentist
License number
12011921B
Date granted
03/04/2014
Date expires
03/01/2016
Class
Controlled Substance Registration - Dentist
Status
Active
Address
Familia Dental, 5328 Coldwater Road, Fort Wayne IN 46825
indianalicensing.org
ID 27545589
LAST UPDATED 2024-03-25 23:27:03 UTC
LAST UPDATED 2024-03-25 23:27:03 UTC
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