License Type:
Dentist
License Number:
2901016219
Name:
Shiva Goltalab-Rad
License Issue Date:
02/08/1993
License Expiration Date:
02/08/2027
License Status:
Active
County:
Washtenaw
City:
Ann Arbor
State or Province:
Michigan
ZIP or Postal Code:
48105
CS Record Number:
5315161313
CS Status:
CS Expiration Date: