POONAM UDAY SHAH DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****24

License Status

NOT RENEWED

Business

First Name

POONAM

Middle

UDAY

Last Name

SHAH

Suffix

DDS

Business Name

POONAM UDAY SHAH DDS

Original Issue Date

07/18/2012

Effective Date

07/18/2012

Expiration Date

09/30/2015

City

MUNSTER

State

Zip

46321

County

INDIANA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016