The holder whose full name is MOLLENKOPF, JACK PHILIP,come from LAFAYETTE IN,hold the CSR-Dentist license(NO.12005880B) which status is Expired.
| Name | MOLLENKOPF, JACK PHILIP |
|---|---|
| License Number | 12005880B |
| License Type | CSR-Dentist |
| License Status | Expired |
| City | LAFAYETTE |
| State | IN |