Indiana
Professional Licensing Agency
Susan Lynn Blackburn
Controlled Substance Registration - Dentist
License number
12007734B
Date granted
07/31/1986
Date expires
03/01/2016
Class
Controlled Substance Registration - Dentist
Status
Active
Address
200 South Dixon Road, Kokomo IN 46901
indianalicensing.org
ID 5106858
LAST UPDATED 2024-04-15 08:24:53 UTC
LAST UPDATED 2024-04-15 08:24:53 UTC
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