License holder summary

Thomas R. Blake is a Dentistry Board - Dental Corporation licensed to practice in Indiana. The address on file for Thomas R. Blake is 2409 FAIROAK DRIVE, FORT WAYNE IN 46809. This licensed professional license is current. The license was granted 12/01/1982 and expired on 01/31/2016.

Indiana

Professional Licensing Agency

Thomas R. Blake
Dentistry Board - Dental Corporation
License number
54000510A
Date granted
12/01/1982
Date expires
01/31/2016
Class
Dentistry Board - Dental Corporation
Status
Active
Address
2409 FAIROAK DRIVE, FORT WAYNE IN 46809
indianalicensing.org
ID 24744388
LAST UPDATED 2024-03-21 16:27:16 UTC

This website is unaffiliated with the Professional Licensing Agency. Please verify all information directly with the relevant official government authority.

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