The holder whose full name is Martin, Edward A.,come from PORTAGE IN,hold the CSR-Dentist license(NO.12006256B) which status is Expired.
| Name | Martin, Edward A. |
|---|---|
| License Number | 12006256B |
| License Type | CSR-Dentist |
| License Status | Expired |
| City | PORTAGE |
| State | IN |