The holder whose full name is Kosek, Douglas John,come from South Bend IN,hold the CSR-Dentist license(NO.12009873B) which status is Active.
| Name | Kosek, Douglas John |
|---|---|
| License Number | 12009873B |
| License Type | CSR-Dentist |
| License Status | Active |
| City | South Bend |
| State | IN |