The holder whose full name is Middaugh, Glen Dale,come from Terre Haute IN,hold the CSR-Dentist license(NO.12010393B) which status is Active.
| Name | Middaugh, Glen Dale |
|---|---|
| License Number | 12010393B |
| License Type | CSR-Dentist |
| License Status | Active |
| City | Terre Haute |
| State | IN |