Indiana
Professional Licensing Agency
Susan Marie Cocquyt
Controlled Substance Registration - Dentist
License number
12009553B
Date granted
07/14/1993
Date expires
03/01/2016
Class
Controlled Substance Registration - Dentist
Status
Active
Address
734 East Ireland Road, South Bend IN 46614
indianalicensing.org
ID 5123598
LAST UPDATED 2024-03-04 01:41:45 UTC
LAST UPDATED 2024-03-04 01:41:45 UTC
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