The holder whose full name is BRUBAKER, DEAN M,come from SHIPSHEWANA IN,hold the CSR-Dentist license(NO.12004993B) which status is Expired.
| Name | BRUBAKER, DEAN M |
|---|---|
| License Number | 12004993B |
| License Type | CSR-Dentist |
| License Status | Expired |
| City | SHIPSHEWANA |
| State | IN |