License holder summary

Tracy Lynn Bacon is a Controlled Substance Registration - Dentist licensed to practice in Indiana. The address on file for Tracy Lynn Bacon is 906 E Washington Ave, South Bend IN 46617. This licensed professional license is current. The license was granted 09/15/1998 and expired on 03/01/2016.

Indiana

Professional Licensing Agency

Tracy Lynn Bacon
Controlled Substance Registration - Dentist
License number
12010041B
Date granted
09/15/1998
Date expires
03/01/2016
Class
Controlled Substance Registration - Dentist
Status
Active
Address
906 E Washington Ave, South Bend IN 46617
indianalicensing.org
ID 5123767
LAST UPDATED 2024-02-04 10:09:33 UTC

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