Indiana
Professional Licensing Agency
Philip W. Gardner
Controlled Substance Registration - Dentist
License number
12007605B
Date granted
07/31/1986
Date expires
03/01/2016
Class
Controlled Substance Registration - Dentist
Status
Active
Address
1234 EAST DUPONT ROAD, FORT WAYNE IN 46825
indianalicensing.org
ID 5095580
LAST UPDATED 2024-04-16 22:55:04 UTC
LAST UPDATED 2024-04-16 22:55:04 UTC
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