Indiana
Professional Licensing Agency
Valerie E. Lake
Controlled Substance Registration - Dentist
License number
12010452B
Date granted
08/12/2002
Date expires
03/01/2016
Class
Controlled Substance Registration - Dentist
Status
Active
Address
Matthew 25 Health & Dental Clinic, 413 East Jefferson Boulevard, Fort Wayne IN 46802
indianalicensing.org
ID 5096468
LAST UPDATED 2024-04-05 18:48:41 UTC
LAST UPDATED 2024-04-05 18:48:41 UTC
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