Continuing Education Provider - Biennial Report

TAT o c::ICi:3 DEPARTMENT OF CONSUMER AFFAIRS 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 | Continuing Education Provider Biennial Report Name of Provider Organization Registered Provider Number RP-Address of Provider Organization Telephone Number ( ) Provider Organization Administrator Name of Contact Person Name of Course Course Identification Number Date(s) Courses Offered Number CE Units Granted Name of Instructor Qualifications of Instructor Summary of Course Content Name of Course Course Identification Number Date(s) Courses Offered Number CE Units Granted Name of Instructor Qualifications of Instructor Summary of Course Content

ca.1.lffqrnia tat dental o• c::ic i:3 department of consumer affairs business, consumer services, and housing agency • governor edmund g. brown jr.

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Transcription of Continuing Education Provider - Biennial Report

1 TAT o c::ICi:3 DEPARTMENT OF CONSUMER AFFAIRS 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 | Continuing Education Provider Biennial Report Name of Provider Organization Registered Provider Number RP-Address of Provider Organization Telephone Number ( ) Provider Organization Administrator Name of Contact Person Name of Course Course Identification Number Date(s) Courses Offered Number CE Units Granted Name of Instructor Qualifications of Instructor Summary of Course Content Name of Course Course Identification Number Date(s) Courses Offered Number CE Units Granted Name of Instructor Qualifications of Instructor Summary of Course Content