EFTA00520949.pdf

Remove your new Pocket License from the receipt portion and carry it with you at all times. Dental Board of California 2005 Evergreen Street, Suite 1550 Sacramento, CA 95815.3831 (Please cut along the dotted lines) cica License No. Dental Board of California 2005 Evergreen Street. Suite 1550 Sacramento. CA 95815.3831 (916)263-2300 Toll Free (877)729-7789 DENTIST Inactive KARYNA SHULIAK 6100 RED HOOK QTRS SUITE B-3 ST THOMAS, VI 00802-1348 Signature Expiration 05/31/2021 Original Issue Date 11/19/2015 Receipt No. 63140 IMPORTANT 1. Please include your license number on any correspondence to this office. 2. Notify the Board of any name or address change in writing. 3. Report any loss immediately in writing to the Board. 4. Please sign and carry the pocket license with you. License No. KARYNA SHULIAK Expiration Date 05/31/2021 This is your RECEIPT. id Id 94E1.20900 in SVIAIOH.L .LS El) 3ins 98.10 )1001103/J001.9 vents VNA2:0O1 9S6 OCIW 03XIVV..0111V kill Please save for your records. MOOS 05/2016 8 I Receipt No. 63140 9 L 996 VO OIN3NPILIOVS 099 L N338O2A3A3 S003 VINLIOAI1VO AO O8VO9 WINK] gs EFTA00520949