Indiana
Professional Licensing Agency
Thomas Ray Blake
Controlled Substance Registration - Dentist
License number
12007973B
Date granted
07/31/1986
Date expires
03/01/2016
Class
Controlled Substance Registration - Dentist
Status
Active
Address
2409 Fairoak Drive, Fort Wayne IN 46809
indianalicensing.org
ID 5096136
LAST UPDATED 2024-02-01 09:41:41 UTC
LAST UPDATED 2024-02-01 09:41:41 UTC
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