The holder whose full name is Puklus, Heather Marie,come from Indianapolis IN,hold the Radiology Student Permit - Dental Radiography license(NO.XS004064) which status is Superceded.
| Name | Puklus, Heather Marie |
|---|---|
| License Number | XS004064 |
| License Type | Radiology Student Permit - Dental Radiography |
| License Status | Superceded |
| City | Indianapolis |
| State | IN |