The holder whose full name is Summerlin, Jack D.,come from Indianapolis IN,hold the CSR-Dentist license(NO.12007904B) which status is Active.
| Name | Summerlin, Jack D. |
|---|---|
| License Number | 12007904B |
| License Type | CSR-Dentist |
| License Status | Active |
| City | Indianapolis |
| State | IN |