Licensee Name: | FAIRBANKS SCOTT CARLYLE |
License Type: | REGISTERED DENTAL HYGIENIST |
License Number: | 21699 |
License Status: | INACTIVE Definition |
Expiration Date: | April 30, 2016 |
Issue Date: | February 01, 2005 |
License or Registration Class: | X |
County: | SONOMA |
Actions: | No |