Secretary John M. Colmers
Maryland Crown Logo Governor Martin O'Malley and Lt. Governor Anthony G. Brown
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 DHMH Home Home | Forms & Applications

 

Forms & Applications

Initial Applications

Reactivation/Reinstatement

Renewal

Application for Recognition as a Specialist

Complaint

Miscellaneous Forms

 
Initial Applications [top of page]
Dentist (by NERB examination)
Adobe .pdf format
MS Word .doc format
Dentist (by waiver of clinical examination)
Adobe .pdf format
MS Word .doc format

Dentist - Limited Dental - Graduate of U.S. or Canadian Dental School
Adobe .pdf format
MS Word .doc format
Dentist - Limited Dental - Graduate of Foreign Dental School
Adobe .pdf format
MS Word .doc format
Dentist - Teacher
Adobe .pdf format
MS Word .doc format
Dentist - Dental Pediatric Fellow
Adobe .pdf format
MS Word .doc format
Dental Hygienist (by NERB examination)
Adobe .pdf format
MS Word .doc format
Dental Hygienist (by waiver of clinical examination)
Adobe .pdf format
MS Word .doc format
Dental Hygienist - Teacher
Adobe .pdf format
MS Word .doc format
Dentist and Dental Auxiliary Personnel Volunteer application  new
Adobe .pdf format
MS Word .doc format
General Anesthesia & Parenteral Sedation Evaluators  new
Adobe .pdf format
MS Word .doc format
Reactivation/Reinstatement [top of page]
Reactivation (Dentist or Dental Hygienist)
Adobe .pdf format
MS Word .doc format
Reactivation Guidelines (Dentist or Dental Hygienist) 
Adobe .pdf format
MS Word .doc format
Reinstatement (Dentist or Dental Hygienist)
Adobe .pdf format
MS Word .doc format
Reinstatement Application  (Dental Radiation Technologist)
Adobe .pdf format
MS Word .doc format
Reinstatement Guidelines (Dental Radiation Technologist) 
Adobe .pdf format
MS Word .doc format
Renewal [top of page]
Dentist
Adobe .pdf format
MS Word .doc format
Dental Hygienist
Adobe .pdf format
MS Word .doc format
Permits (General Anesthesia Admin/Facility & Parenteral Sedation Admin./Facility )
Adobe .pdf format
MS Word .doc format
Application for Recognition as a Specialist [top of page]
Application for Recognition as a Specialist
Adobe .pdf format
MS Word .doc format
Complaint [top of page]
Complaint Form
Adobe .pdf format
MS Word .doc format
Miscellaneous Forms [top of page]
Change of Information (name, address, etc.)
Adobe .pdf format
MS Word .doc format
Application for Corporate Name
Adobe .pdf format
MS Word .doc format

 
 
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 Updated 08/07/2008