The holder whose full name is Lewis, Jay Vincent,come from Logansport IN,hold the CSR-Dentist license(NO.12008646B) which status is Active.
| Name | Lewis, Jay Vincent |
|---|---|
| License Number | 12008646B |
| License Type | CSR-Dentist |
| License Status | Active |
| City | Logansport |
| State | IN |