The holder whose full name is Kenworthy, David James,come from Bloomington IN,hold the CSR-Dentist license(NO.12006724B) which status is Active.
| Name | Kenworthy, David James |
|---|---|
| License Number | 12006724B |
| License Type | CSR-Dentist |
| License Status | Active |
| City | Bloomington |
| State | IN |