The holder whose full name is Bausman, Gordon,come from Rensselaer IN,hold the Dentist license(NO.12007571A) which status is Inactive.
| Name | Bausman, Gordon |
|---|---|
| License Number | 12007571A |
| License Type | Dentist |
| License Status | Inactive |
| City | Rensselaer |
| State | IN |