DANA BROCK MD
Controlled Substance Registration for Practitioner


Address: 160 Tokeneke Dr, N Haven, CT 06473

DANA BROCK MD (Credential# 152663) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is August 17, 1994. The license expiration date date is July 1, 1996. The license status is INACTIVE.

Business Overview

DANA BROCK MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0008963. The credential type is controlled substance registration for practitioner. The effective date is August 17, 1994. The expiration date is July 1, 1996. The business address is 160 Tokeneke Dr, N Haven, CT 06473. The current status is inactive.

Basic Information

Licensee Name DANA BROCK MD
Credential ID 152663
Credential Number CSP.0008963
Credential Type CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER
Business Address 160 Tokeneke Dr
N Haven
CT 06473
Business Type INDIVIDUAL
Status INACTIVE
Effective Date 1994-08-17
Expiration Date 1996-07-01
Refresh Date 2009-01-26

Office Location

Street Address 160 TOKENEKE DR
City N HAVEN
State CT
Zip Code 06473

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Competitor

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City N HAVEN
Zip Code 06473
License Type CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER
License Type + County CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + N HAVEN

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Dataset Information

Data Provider Connecticut Department of Consumer Protection
Jurisdiction Connecticut
Related Datasets Connecticut Business Registrations, Connecticut Child Care Facilities

This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).

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