The holder whose full name is Long, Shawn Ray,come from Granger IN,hold the CSR-Dentist license(NO.12009672B) which status is Expired.
| Name | Long, Shawn Ray |
|---|---|
| License Number | 12009672B |
| License Type | CSR-Dentist |
| License Status | Expired |
| City | Granger |
| State | IN |