The holder whose full name is Azad, Koushan Haidarzadeh,come from Fort Wayne IN,hold the CSR-Dentist license(NO.12011918B) which status is Active.
| Name | Azad, Koushan Haidarzadeh |
|---|---|
| License Number | 12011918B |
| License Type | CSR-Dentist |
| License Status | Active |
| City | Fort Wayne |
| State | IN |