The holder whose full name is ISH, ROGER ETHAN,come from WATERLOO IN,hold the CSR-Dentist license(NO.12004517B) which status is Expired.
| Name | ISH, ROGER ETHAN |
|---|---|
| License Number | 12004517B |
| License Type | CSR-Dentist |
| License Status | Expired |
| City | WATERLOO |
| State | IN |