**Please note that your answers on the supplemental questionnaire must correspond to the information provided on your application to receive credit. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.**
1.
Are you currently licensed as a Dentist by the Maryland Board of Dental Examiners?
Yes
No
2.
If you answered Yes to the above question, please provide your license number and expiration date in the space below. If you do not possess a certificate of eligibility, please indicate N/A in the text box below.
3.
Describe your experience in the practice of dentistry. Please include name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application. If you do not possess experience in this area, put N/A in the box below.
4.
Describe your experience as a general dentist seeing adults and children, completing exams, fillings, SDF (silver diamine fluoride), sealants, extractions, and crowns, as well as treating abscesses and performing other procedures that do not require an operating room or pediatric referral for further sedation.
This experience should be included on your application, including hours and dates worked. If you do not possess this type of experience, please put N/A in the text box.
5.
Describe your experience with the use of nitrous oxide.
This experience should be included on your application, including hours and dates worked. If you do not possess this type of experience, please put N/A in the text box.
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