Indiana
Professional Licensing Agency
Sonya Ann Shively
Controlled Substance Registration - Dentist
License number
12010188B
Date granted
08/13/1999
Date expires
03/01/2016
Class
Controlled Substance Registration - Dentist
Status
Active
Address
4616 West Jefferson Boulevard, Fort Wayne IN 46804-6826
indianalicensing.org
ID 5095945
LAST UPDATED 2024-02-27 12:05:37 UTC
LAST UPDATED 2024-02-27 12:05:37 UTC
This website is unaffiliated with the Professional Licensing Agency. Please verify all information directly with the relevant official government authority.