Remove vo Pocket Li Dental Board of California mov your new ocke icense i from the receipt portion and carry it 2005 Evergreen a Suite 1550 with you at all times. Sacramento, CA 95815-3831 (Please cut along the dotted lines) Dental Board of California = | IMPORTANT 2005 Evergreen Street, Suite 1550 rm H : Sacramento, CA 95815-3831 i 1 Please include your license number on any — (916) 263-2300 ~- e H correspondence to this office i Toll Free (877) 729-7789, : i | | ws H 2. Notify the Board of any name or address change in 1 eenasrmet or commen re DENTIST = i writing | License No. Expiration H 3. Report any loss immediately in writing to the Board Inact j neue 05/31/2021 Please sign and carry the pocket license with you H a ee a H License No Expiration Date Receipt No. | SuTees 11/19/2015 | | 05/31/2021 63140 | ST THOMAS, VI 00802-1348 H KARYNA SHULIAK | Receipt No. i i err 63140 This is your RECEIPT. Please save for your records. | | POEDDS 05/2016 _ bd tL 8PEL-Z0800 IA SVWOHL LS €-8 SLINS SYULO HOOH G3x 0019 MVMNHS WNAUY 996 DOV DSXINcOLNVereeee Ett Nagy lyMbagongagef ped foed at peed poe yg MAfL peg plot] foley SL8S6 VO OLNSWVYeOVS OSS SLINS ‘LS N33SYONSAS S00z VINNOSITV9 40 GYVO8 WLN3d EFTA00520949 JOROOORSS 133-2011 9980972'X9K4R42-00057-M0000352-00 1-HONA IAS. Pew 3-S000000 1-1/1