The holder whose full name is DEJEAN, EDGAR KENNETH,come from SALEM IN,hold the CSR-Dentist license(NO.12004509B) which status is Expired.
| Name | DEJEAN, EDGAR KENNETH |
|---|---|
| License Number | 12004509B |
| License Type | CSR-Dentist |
| License Status | Expired |
| City | SALEM |
| State | IN |