The holder whose full name is Fontaine, Richard Alan,come from Attica IN,hold the CSR-Dentist license(NO.12006191B) which status is Expired.
| Name | Fontaine, Richard Alan |
|---|---|
| License Number | 12006191B |
| License Type | CSR-Dentist |
| License Status | Expired |
| City | Attica |
| State | IN |