The holder whose full name is Johnson, Mark R.,come from NORTH VERNON IN,hold the CSR-Dentist license(NO.12008101B) which status is Expired.
| Name | Johnson, Mark R. |
|---|---|
| License Number | 12008101B |
| License Type | CSR-Dentist |
| License Status | Expired |
| City | NORTH VERNON |
| State | IN |