WANDA F PUCKETT DDS
Controlled Substance Registration for Practitioner


Address: 65 Old Rte 79 #1, Madison, CT 06443

WANDA F PUCKETT DDS (Credential# 245267) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2015. The license expiration date date is February 28, 2017. The license status is INACTIVE.

Business Overview

WANDA F PUCKETT DDS is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0030274. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2015. The expiration date is February 28, 2017. The business address is 65 Old Rte 79 #1, Madison, CT 06443. The current status is inactive.

Basic Information

Licensee Name WANDA F PUCKETT DDS
Credential ID 245267
Credential Number CSP.0030274
Credential Type CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER
Business Address 65 Old Rte 79 #1
Madison
CT 06443
Business Type INDIVIDUAL
Status INACTIVE
Effective Date 2015-03-01
Expiration Date 2017-02-28
Refresh Date 2018-01-29

Other licenses

ID Credential Code Credential Type Issue Term Status
703198 2.008746 Dentist 2000-05-25 2014-09-01 - 2015-08-31 INACTIVE

Office Location

Street Address 65 OLD RTE 79 #1
City MADISON
State CT
Zip Code 06443

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Competitor

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City MADISON
Zip Code 06443
License Type CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER
License Type + County CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + MADISON

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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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