Collette Elke Supit
ExpiredCalifornia license 104642
License
- Licensed by
- Dental Board of California
- License number
- 104642
- Status
- Expired (Delinquent)
- First issued
- December 19, 2019
- Expired
- April 30, 2026
- License holder
- Collette Elke Supit
- Entity type
- Individual
Classifications
- Dental License Dental
More from the license record
- License type code
- 4401
Contact
154 Calachucha Avenue
Barrigada, GU 96913
Barrigada, GU 96913
Guam County