Koushan Haidarzadeh Azad

Controlled Substance Registration - Dentist

Indiana  12011918B   Active

This Indiana license is held by Koushan Haidarzadeh Azad. The license is currently active. It was granted on 03/13/2013 and expired on 03/01/2016

LICENSE DETAILS

  • License Number: 12011918B
  • Category: CSR-Dentist
  • Status: Active
  • Date Granted: 03/13/2013 (about 12 years ago)
  • Expiry Date: 03/01/2016 (about 9 years ago)

LOCATIONS

A Address

Familia Dental, 5328 Coldwater Road, Fort Wayne IN 46825