The holder whose full name is Allen, David Matthew,come from FORT WAYNE IN,hold the CSR-Dentist license(NO.12008539C) which status is Expired.
| Name | Allen, David Matthew |
|---|---|
| License Number | 12008539C |
| License Type | CSR-Dentist |
| License Status | Expired |
| City | FORT WAYNE |
| State | IN |