The holder whose full name is LEWIS, BENJAMIN IVAN,come from GAS CITY IN,hold the Dentist license(NO.12004756A) which status is Expired.
| Name | LEWIS, BENJAMIN IVAN |
|---|---|
| License Number | 12004756A |
| License Type | Dentist |
| License Status | Expired |
| City | GAS CITY |
| State | IN |