The holder whose full name is Bussick, Timothy Jay,come from Fort Wayne IN,hold the Dental Intern Permit license(NO.42000056A) which status is Expired.
| Name | Bussick, Timothy Jay |
|---|---|
| License Number | 42000056A |
| License Type | Dental Intern Permit |
| License Status | Expired |
| City | Fort Wayne |
| State | IN |