Indiana
Professional Licensing Agency
Theresa Ann Stakem
Controlled Substance Registration - Dentist
License number
12009924B
Date granted
03/12/1997
Date expires
03/01/2016
Class
Controlled Substance Registration - Dentist
Status
Active
Address
54561 Oak Leaf Drive, Mishawaka IN 46545
indianalicensing.org
ID 5123703
LAST UPDATED 2024-04-12 16:18:37 UTC
LAST UPDATED 2024-04-12 16:18:37 UTC
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