The holder whose full name is SMITH, CHARLES DUDLEY,come from LAFAYETTE IN,hold the CSR-Dentist license(NO.12004532B) which status is Expired.
| Name | SMITH, CHARLES DUDLEY |
|---|---|
| License Number | 12004532B |
| License Type | CSR-Dentist |
| License Status | Expired |
| City | LAFAYETTE |
| State | IN |