The holder whose full name is CHIDALEK, ANTHONY J,come from La Porte IN,hold the CSR-Dentist license(NO.12005001B) which status is Expired.
| Name | CHIDALEK, ANTHONY J |
|---|---|
| License Number | 12005001B |
| License Type | CSR-Dentist |
| License Status | Expired |
| City | La Porte |
| State | IN |