The holder whose full name is Goris, Dale Edwin,come from LOGANSPORT IN,hold the CSR-Dentist license(NO.12005116B) which status is Expired.
| Name | Goris, Dale Edwin |
|---|---|
| License Number | 12005116B |
| License Type | CSR-Dentist |
| License Status | Expired |
| City | LOGANSPORT |
| State | IN |