| 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 |