Tatyana Prosolupova
ExpiredCalifornia license 105166
License
- Licensed by
- Dental Board of California
- License number
- 105166
- Status
- Expired (Delinquent)
- First issued
- August 3, 2020
- Expired
- July 31, 2024
- License holder
- Tatyana Prosolupova
- Entity type
- Individual
Classifications
- Dental License Dental
More from the license record
- License type code
- 4401
Contact
195 Tamal Vista Blvd Apt 409
Corte Madera, CA 94925
Corte Madera, CA 94925
Marin County