The holder whose full name is Hallberg, Glenn Carl,come from FORT WAYNE IN,hold the CSR-Dentist license(NO.12007994C) which status is Expired.
| Name | Hallberg, Glenn Carl |
|---|---|
| License Number | 12007994C |
| License Type | CSR-Dentist |
| License Status | Expired |
| City | FORT WAYNE |
| State | IN |