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Forms & Applications

 Updated on 10/24/2018
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DENTIST
Initial Application (by NERB examination)

Download

Initial Application (Licensed in another state) Download
Initial  Limited Dental - Graduate of U.S. or Canadian Dental School Download
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

Downloa​d
Retired Volunteer Application Download
​Ownership of a Dental Practice Download​
Application for Recognition as a Specialist

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​​
DENTAL HYGIENIST
Initial Application (by NERB examination)

Download

Initial Application (Licensed in another state)

Download
​Dental Hygienist Volunteer Application Download
​Retired Volunteer Application Download​
Dental Hygiene Waiver of Supervision
Download
​Applicant NOT recognized to administer local anesthesia in another state Download​
Applicant recognized to administer local anesthesia in another state Download​
​Applicant NOT recognized to administer local anesthesia (BLOCK) in another state Download
Applicant recognized to administer local (BLOCK) in another state Download​
​Applicant recognized to administer Nitrous Oxide  Download​
​Applicant recognized to administer Nitrous Oxide in another state ​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
SEDATION PERMITS
Application for Initial Anesthesia and Sedation Permits and Certificates Download
​2018 Anesthesia Permit- Certification Renewal Download​
​2018 Anesthesia Permit- Certifcation Renewal Affidavit Download​​
MISCELLANEOUS FORMS
Photo Affidavit- All license types Download
Change of Information (name, address, etc.) Download
Roster Request Form Download
Reactivation of an Inactive License- Dentist & Hygienist
​Download​
Reinstatement of Expired License- Dentist, Dental Hygienist, Dental Teacher
Download​
Application for Corporate Name Download

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