STEPHEN R FUGAJ Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****62

License Status

ACTIVE

Business

First Name

STEPHEN

Middle

Last Name

FUGAJ

Business Name

STEPHEN R FUGAJ

Original Issue Date

05/24/2012

Effective Date

09/03/2024

Expiration Date

09/30/2027

City

DYER

State

Zip

46311

County

INDIANA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/03/2024