Gary Richard Forman
ExpiredCalifornia license 34098
License
- Licensed by
- Dental Board of California
- License number
- 34098
- Status
- Expired (Delinquent)
- First issued
- September 23, 1985
- Expired
- April 30, 2022
- License holder
- Gary Richard Forman
- Entity type
- Individual
Classifications
- Dental License Dental
More from the license record
- License type code
- 4401
Contact
12 Evergreen Dr
Orinda, CA 94563-3115
Orinda, CA 94563-3115
Contra Costa County