The holder whose full name is BAKER, DALE A,come from LOGANSPORT IN,hold the CSR-Dentist license(NO.12005091B) which status is Expired.
| Name | BAKER, DALE A |
|---|---|
| License Number | 12005091B |
| License Type | CSR-Dentist |
| License Status | Expired |
| City | LOGANSPORT |
| State | IN |