EFTA00525157.pdf

Dental Board of California Remove your new Pocket License from the receipt portion and carry ft 2005 Evergreen Street, Suite 1550 with you at all times. Sacramento, CA 95815-3831 (916) 263-2300 / Toll Free (877) 729.7789 (Please cut along the dotted lines) Dental Board of California IMPORTANT 2005 Evergreen Street. Suite 1550 Sacramento. CA 95815.3831 1. Please include your license number on any dea (916)263-2300 correspondence to this office. Toll Free (877) 720.7789 2. Notify the Board of any name or address change in DENTIST writing. License No. Expiration 3. Report any loss immediately in writing to the Board. DDS65268 05/31/2019 4. Please sign and carry the pocket license with you. Original KARYNA SHULIAK License No. Expiration Date Receipt No. Issue Date 6100 RED HOOK QUARTER SUITE B-3 11/19/2015 DDS65268 05/31/2019 32138 ST. THOMAS, VI 00802 KARYNA SWUM( Receipt NO. Signature 32138 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