The holder whose full name is Phelps, Jason Matthew,come from Losantville IN,hold the CSR-Dentist license(NO.12010459B) which status is Expired.
| Name | Phelps, Jason Matthew |
|---|---|
| License Number | 12010459B |
| License Type | CSR-Dentist |
| License Status | Expired |
| City | Losantville |
| State | IN |