Transcription of Dental Board of California - Application for Registered ...
{{id}} {{{paragraph}}}
Example: bachelor of science
Dental Board of California - Application for Registered ...
BUSINESS, CONSUMER SERVICES, AND HOUSING AGENCY GAVIN NEWSOM, GOVERNOR Dental Board OF California 2005 Evergreen St., Suite 1550, Sacramento, CA 95815 P (916) 263-2300 | F (916) 263-2140 | Application FOR Registered Dental assistant (RDA) examination AND LICENSURESee Instructions for completing and filing this Application . Please read carefully and answer each question fully. Falsification or misrepresentation of any item or response on this Application or any attachment hereto is sufficient basis for denying or revoking a license. For Office Use Only For Office Use Only Date Received Rec # _____ Fee Paid: _____ Non-Refundable Fees Application : $120 A written examination fee will be required to be paid directly to PSI at a later date.
Application for Registered Dental Assistant (RDA) Examination and Licensure . Non-Refundable Fees . For Office Use Only For Office Use Only . Date Received Application: $120 A written examination fee will be required to be paid directly to PSI at a Rec # Fee Paid: later date. Cashiered: Entity # File # _ (Please Print or Type) 1. SSN/ITIN#: 2.
Tags:
Information
Domain:
Source:
Link to this page:
Please notify us if you found a problem with this document: