The holder whose full name is Henderson, David J.,come from BLOOMINGTON IN,hold the CSR-Dentist license(NO.12007864B) which status is Expired.
| Name | Henderson, David J. |
|---|---|
| License Number | 12007864B |
| License Type | CSR-Dentist |
| License Status | Expired |
| City | BLOOMINGTON |
| State | IN |