The holder whose full name is Wagner, Brian Matthew,come from Huntingburg IN,hold the CSR-Dentist license(NO.12010568B) which status is Active.
| Name | Wagner, Brian Matthew |
|---|---|
| License Number | 12010568B |
| License Type | CSR-Dentist |
| License Status | Active |
| City | Huntingburg |
| State | IN |