The holder whose full name is Detterline, David Austin,come from Lafayette IN,hold the CSR-Dentist license(NO.12010870B) which status is Expired.
| Name | Detterline, David Austin |
|---|---|
| License Number | 12010870B |
| License Type | CSR-Dentist |
| License Status | Expired |
| City | Lafayette |
| State | IN |