Indiana
Professional Licensing Agency
Randolph Ken Shoup
Controlled Substance Registration - Dentist
License number
12008036B
Date granted
03/31/1986
Date expires
03/01/2016
Class
Controlled Substance Registration - Dentist
Status
Active
Address
14540 Prairie Lakes Boulevard North Suite 205, Noblesville IN 46060
indianalicensing.org
ID 5116870
LAST UPDATED 2024-04-01 21:32:37 UTC
LAST UPDATED 2024-04-01 21:32:37 UTC
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