The holder whose full name is Modesto, Edward Louis,come from Orland Park IL,hold the Dentist license(NO.12006969A) which status is Inactive.
| Name | Modesto, Edward Louis |
|---|---|
| License Number | 12006969A |
| License Type | Dentist |
| License Status | Inactive |
| City | Orland Park |
| State | IL |