License holder summary

Timothy D. Provence is a Controlled Substance Registration - Dentist licensed to practice in Indiana. The address on file for Timothy D. Provence is 7126 NORTH SHADELAND AVENUE, INDIANAPOLIS IN 46250. This licensed professional license is not current. The license was granted 06/20/1984 and expired on 07/31/1985.

Indiana

Professional Licensing Agency

Timothy D. Provence
Controlled Substance Registration - Dentist
License number
12008606B
Date granted
06/20/1984
Date expires
07/31/1985
Class
Controlled Substance Registration - Dentist
Status
Expired
Address
7126 NORTH SHADELAND AVENUE, INDIANAPOLIS IN 46250
indianalicensing.org
ID 5104697
LAST UPDATED 2024-04-03 22:33:29 UTC

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