EFTA00525157.pdf

Remove your new Pocket License from the receipt portion and carry ft with you at all times. (Please cut along the dotted lines) de a License No. DDS65268 Dental Board of California 2005 Evergreen Street. Suite 1550 Sacramento. CA 95815.3831 (916)263-2300 Toll Free (877)720.7789 DENTIST KARYNA SHULIAK 6100 RED HOOK QUARTER SUITE B-3 ST. THOMAS, VI 00802 Signature Expiration 05/31/2019 Original Issue Date 11/19/2015 Receipt NO. 32138 Dental Board of California 2005 Evergreen Street, Suite 1550 Sacramento, CA 95815-3831 (916) 263-2300 / Toll Free (877) 729.7789 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. Expiration Date Receipt No. DDS65268 05/31/2019 32138 KARYNA SWUM( This Is your RECEIPT. Please save for your records. POEDDS 05'2016 30900 IA 'SV110141 C-9 311f1S a0000 83.18V110 NOOH 03d 000 min Nvtinlis vNAtiv>i SL8S6 VO 01N3VIVLIOVS Oggi. 311115 '19 N338083A3 SOOT VIN80Allt10 JO 023V08 1V.LN3O EFTA00525157