Case File
efta-efta00524025DOJ Data Set 9OtherApplication Summary
Date
Unknown
Source
DOJ Data Set 9
Reference
efta-efta00524025
Pages
1
Persons
0
Integrity
Extracted Text (OCR)
Text extracted via OCR from the original document. May contain errors from the scanning process.
Application Summary
3/26/19 11:30 AM
License Type:
License Number:
File Number:
Application:
Application Number:
Application Date:
Dentist
51564
Change of Address
6822987
03/26/2019 (mm/dd/yyyy)
Page 1 of 1
Personal Detail
First Name:
Last Name:
KARYNA
SHULIAK
Addresses
License Related Addresses
Address of Record
Warning:
Confidential Address
Warning:
In order to protect your privacy and identity,
address will not be displayed.
In order to protect your privacy and identity,
address will not be displayed.
Effective Date of Address Change
Effective Date:
03/26/2019 (mm/dd/yyyy)
Attachments
Attestation
I certify under the penalty of perjury, under the law of the State of California that the information
in this application and any attachments are true and correct.
Signature:
1553675054294
EFTA00524025
Technical Artifacts (2)
View in Artifacts BrowserEmail addresses, URLs, phone numbers, and other technical indicators extracted from this document.
Phone
3675054294Phone
6822987Related Documents (6)
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