TARISA CELESTE SHAKE Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020003821

License Status

NOT RENEWED

Business

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

City

BOISE

State

Zip

83704

County

IDAHO

Ever Disciplined

LastModifiedDate

10/17/2005