The holder whose full name is Shafer, Mark Duane,come from Granger IN,hold the CSR-Dentist license(NO.12009526C) which status is Active.
| Name | Shafer, Mark Duane |
|---|---|
| License Number | 12009526C |
| License Type | CSR-Dentist |
| License Status | Active |
| City | Granger |
| State | IN |