Official SealDepartment of Budget and Management


#18-004236-0002
Supplemental Questionnaire

Last Name
First Name
1

Do you possess a current license as a Dentist from the Maryland State Board of Dental Examiners?

Yes No
2

Please describe in the box below your post-dental school experience in the practice of dentistry in an institutional setting or public health program. Please include the name of employer, job title, dates and number of hours worked. This information must also be included on your application. If you do not have this experience, please enter N/A in the field below.

3

Please describe your experience in the practice of pediatric dentistry working with adolescents.   Please include the name of employer, job title, dates and number of hours worked.  This information must also be included on your application.  If you do not have this experience, please enter N/A in the field below.

 


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