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Forms & Applications


DENTIST
Initial Application (by NERB Examination)

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Initial Application (Licensed in another state)

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Initial  Limited Dental - Graduate of U.S. or Canadian Dental School
Initial Application for a Teacher’s License – Dentistry/ Dental Hygiene
DOWNLOAD
Initial Limited Dental - Graduate of Foreign Dental School

DOWNLOAD

Initial ​Application for Foreign Trained Dentists- University of Maryland Dental School Faculty by Examination DOWNLOAD​
Dental Pediatric Fellow ​DOWNLOAD

Dental Volunteer Application

DOWNLOAD​

​Dentist Temporary Volunteer Application

DOWNLOAD
Retired Volunteer Application DOWNLOAD
Reinstatement of  Dental License DOWNLOAD
​Ownership of a Dental Practice Download​
Specialty Application

DOWNLOAD​

​Full Drug Dispensing Permit Application DOWNLOAD​
​Limited Drug Dispensing Permit Application DOWNLOAD
​Expert Witness Application ​Download
​Application to Participate In An Advanced Clinical Training Program For Continuing Education At The University of Maryland Dental School DOWNLOAD
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​​2022 Dentist Renewal Application- New

​​Download

​2022 Dentist CE Audit Form - New
Download​
DENTAL HYGIENIST
​​Initial Application (by ADEX/NERB Examination)

Initial Application (Licensed in another state)

DOWNLOAD
​Dental Hygienist Temporary Volunteer Application DOWNLOAD
​Dental Hygienist Volunteer Application Download​
Dental Hygiene Waiver of Supervision
Download
​Applicant (NOT Recognized) to Administer Local Anesthesia (BLOCK) in another state Download
Applicant (Recognized) to Administer Local Anesthesia (BLOCK) in another state DOWNLOAD
​Applicant (Recognized) to Administer Nitrous Oxide  DOWNLOAD
​Applicant (Recognized) to Administer Nitrous Oxide in another state DOWNLOAD
​​2022 Dental Hygienist Renewal Application - New
Download​
​​​2022 Dental Hygiene CE Audit Form- New

DOWNLOAD

DENTAL RADIATION TECHNOLOGIST

Initial Dental Radiation Technologist by Waiver Download
Initial Dental Radiation Technologist by Examination Download​​​
Initial Qualified Dental Assistant- General Download
​Initial Qualified Dental Assistant- Orthodontics Download
Reinstatement of a Dental Radiation Technologist Certification Download​
2022 Dental Radiation Technologist Renewal Application​
N/A
​2022 Dental Radiation Technologist Renewal Instructions 
N/A​​
SEDATION PERMITS
​Initial Applicat​ion for Anesthesia and Sedation Permits and Certificates Download
​2022 Anesthesia and Sedation Renewal Application Download​
​2022 Anesthesia and Sedation Affidavit 

Downloa​d​
MISCELLANEOUS FORMS
Photo Affidavit- All license types Download
Change of Information (Name, Address, etc.) Download
Roster Request Form- Updated D​ownloand
Reactivation of an Inactive License- Dentist & Hygienist
DOWNLOAD​
Reinstatement of Expired License- Dentist, Dental Hygienist, Dental Teacher
Download​​
Application for Corporate Name

DOWNLOAD​

Continuing Education Extension Request Form
Advanced Clinical Training Program - All Entities​​
DOWNLOAD
Revised 3/8/2022

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