The holder whose full name is Fridh, Daniel Walter,come from La Porte IN,hold the CSR-Dentist license(NO.12007235B) which status is Active.
| Name | Fridh, Daniel Walter |
|---|---|
| License Number | 12007235B |
| License Type | CSR-Dentist |
| License Status | Active |
| City | La Porte |
| State | IN |