The holder whose full name is O SHAUGHNESSY, PHILLIP E,come from FORT WAYNE IN,hold the Dentist - Light Parenteral Conscious Sedation license(NO.12005741A) which status is Inactive/Expired.
| Name | O SHAUGHNESSY, PHILLIP E |
|---|---|
| License Number | 12005741A |
| License Type | Dentist - Light Parenteral Conscious Sedation |
| License Status | Inactive/Expired |
| City | FORT WAYNE |
| State | IN |