Indiana
Professional Licensing Agency
Thomas Michael Banta
Controlled Substance Registration - Dentist
License number
12008772B
Date granted
07/30/1986
Date expires
03/01/2016
Class
Controlled Substance Registration - Dentist
Status
Active
Address
1413 West Votaw Street, Portland IN 47371
indianalicensing.org
ID 5119262
LAST UPDATED 2024-02-21 20:19:30 UTC
LAST UPDATED 2024-02-21 20:19:30 UTC
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