Prathip Sivaprakasam
Controlled Substance Registration - Dentist
Indiana 12011107B Expired
This Indiana license was held by Prathip Sivaprakasam. The license is no longer active. It was granted on 05/01/2008 and expired on 03/01/2012
LICENSE DETAILS
- License Number: 12011107B
- Category: CSR-Dentist
- Status: Expired
- Date Granted: 05/01/2008 (about 17 years ago)
- Expiry Date: 03/01/2012 (over 13 years ago)
LOCATIONS
A Address
1515 West 45th Ave., Griffith IN 46319