The holder whose full name is Thneibat, Amenah,come from Lafayette IN,hold the CSR-Dentist license(NO.12011625B) which status is Active.
| Name | Thneibat, Amenah |
|---|---|
| License Number | 12011625B |
| License Type | CSR-Dentist |
| License Status | Active |
| City | Lafayette |
| State | IN |