The holder whose full name is Shields, Brian D.,come from Demotte IN,hold the CSR-Dentist license(NO.12009921B) which status is Active.
| Name | Shields, Brian D. |
|---|---|
| License Number | 12009921B |
| License Type | CSR-Dentist |
| License Status | Active |
| City | Demotte |
| State | IN |