The holder whose full name is BLAKE, THOMAS LEE,come from MUNCIE IN,hold the Dentist - GADS license(NO.12005289A) which status is Expired.
| Name | BLAKE, THOMAS LEE |
|---|---|
| License Number | 12005289A |
| License Type | Dentist - GADS |
| License Status | Expired |
| City | MUNCIE |
| State | IN |