TARISA CELESTE SHAKE - Dentist License in Idaho | # 020003821

TARISA CELESTE SHAKE

Business Entity

NOT RENEWED

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020003821

License Status

NOT RENEWED

Business

N

First Name

TARISA CELESTE

Last Name

SHAKE

Business Name

TARISA CELESTE SHAKE

Original Issue Date

06/29/1979

Effective Date

06/29/1979

Expiration Date

09/30/2002

State

ID

Ever Disciplined

N

LastModifiedDate

10/17/2005