The holder whose full name is Ellison, Robert Paul,come from Fort Wayne IN,hold the CSR-Dentist license(NO.12006593B) which status is Active.
| Name | Ellison, Robert Paul |
|---|---|
| License Number | 12006593B |
| License Type | CSR-Dentist |
| License Status | Active |
| City | Fort Wayne |
| State | IN |