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    Maryland Department of Health
    Dental

    ​​​​​​​​​​​​​​​​​​​​​​​​​​​
    Forms & Applications

     Updated on 07/28/2021

    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
    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

    2020 DENTIST RENEWAL APPLICATION -Fillable

    		 DOWNLOAD

    ​2021 DENTIST RENEWAL APPLICATION - Fillable

    		 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

    ​2020 DENTAL HYGIENE RENEWAL APPLICATION -  Fillable

    		 DOWNLOAD​​​

    ​2021 DENTAL HYGIENE RENEWAL APPLICATION - Fillable

    		  ​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​
    		​Download​​
    ​2022 Dental Radiation Technologist Renewal Instructions 
    		​Download​​​​
    SEDATION PERMITS
    ​Applicat​ion for Anesthesia and Sedation Permits and Certificates Download​
    ​2021 Anesthesia Permit- Certification Renewal Download​
    ​2021 Anesthesia Permit- Certification Renewal Affidavit Download​
    MISCELLANEOUS FORMS
    ​Photo Affidavit- All license types Download
    Change of Information (Name, Address, etc.) Download
    Roster Request Form- Updated ​Download​​
    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​

    ​​​​