Jack Sylvester Broussard Jr
InactiveCalifornia license 26040
License
- Licensed by
- Dental Board of California
- License number
- 26040
- Status
- Inactive (CurrentInactive)
- First issued
- October 5, 1976
- Expires
- February 28, 2027
- License holder
- Jack Sylvester Broussard Jr
- Entity type
- Individual
Classifications
- Dental License Dental
More from the license record
- License type code
- 4401
Contact
1801 Ramona Ave
South Pasadena, CA 91030-4427
South Pasadena, CA 91030-4427
Los Angeles County