Remove your new Pocket License from the receipt portion and carry it Dental Board of California 2005 Evergreen Street, Suite 1550 Sacramento, CA 95815-3831 with you at all times. (916) 263-2300 / Toll Free (877) 729-7789 (Please cut along the dotted lines) Dental Board of California IMPORTANT 2005 Evergreen Street, Suite 1550 ve : Sacramento, CA 95815-3831 1. Please include your license number on any (916) 263-2300 correspondence to this office. T 77 7 ones fT eee 2. Notify the Board of any name or address change in writing. Expiration 3. Report any loss immediately in writing to the Board, 05/31/2019 4. Please sign and carry the pocket license with you. KARYNA SHULIAK by al License No, Expiration Date Receipt No. 6100 RED HOOK QUARTER SUITE B-3 11/19/2015 DDS65268 05/31/2019 32138 ST. THOMAS, VI 00802 KARYNA Receipt No. SHULIAK Signature 0 32138 Please save for your records. This is your RECEIPT. POEODS 05/2016 20800 IA ‘SVWOHL ‘LS £8 SLINS z10000 YaLYVND MOOH G3x 0019 7K YVITINHS VNANY™ Fes SL8S6 WO OLNSWVeovS OSS SLINS ‘LS N33YNOYNSAZ $00 VINSOSITV9 40 GYVO8 WWLN30 | AAR ARRAN AN anne es, pie menanmmmen EFTA00525157