License holder summary

Russell Eric Gilliom is a Controlled Substance Registration - Dentist licensed to practice in Indiana. The address on file for Russell Eric Gilliom is 230 East Whitley St. P.O. Box 265, Churubusco IN 46723-0265. This licensed professional license is not current. The license was granted 11/30/1984 and expired on 03/01/2014.

Indiana

Professional Licensing Agency

Russell Eric Gilliom
Controlled Substance Registration - Dentist
License number
12007296B
Date granted
11/30/1984
Date expires
03/01/2014
Class
Controlled Substance Registration - Dentist
Status
Expired
Address
230 East Whitley St. P.O. Box 265, Churubusco IN 46723-0265
indianalicensing.org
ID 5086651
LAST UPDATED 2024-01-25 15:22:03 UTC

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