The holder whose full name is Devitt, Timothy Jacob,come from Bloomington IN,hold the Dental Intern Permit license(NO.42000243A) which status is Superceded.
| Name | Devitt, Timothy Jacob |
|---|---|
| License Number | 42000243A |
| License Type | Dental Intern Permit |
| License Status | Superceded |
| City | Bloomington |
| State | IN |