The holder whose full name is Larsen, Frederick,come from WASHINGTON IN,hold the CSR-Dentist license(NO.12007686B) which status is Suspended.
| Name | Larsen, Frederick |
|---|---|
| License Number | 12007686B |
| License Type | CSR-Dentist |
| License Status | Suspended |
| City | WASHINGTON |
| State | IN |