The holder whose full name is Chung, Daniel,come from South Bend IN,hold the CSR-Dentist license(NO.12011089B) which status is Expired.
| Name | Chung, Daniel |
|---|---|
| License Number | 12011089B |
| License Type | CSR-Dentist |
| License Status | Expired |
| City | South Bend |
| State | IN |