The holder whose full name is Back, Theresa Lynn,come from Indianapolis IN,hold the Dental Hygiene Anesthesia Permit license(NO.89000245A) which status is Active.
| Name | Back, Theresa Lynn |
|---|---|
| License Number | 89000245A |
| License Type | Dental Hygiene Anesthesia Permit |
| License Status | Active |
| City | Indianapolis |
| State | IN |