Course:
Smile! Oral Health for Everyone (for Com...
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Organization/Workplace
Dental License Number
(Enter 0000 if you do not have a number)
Zip Code of Residence
County of Residence
Zip Code of Workplace
County of Workplace
Please choose your primary position
Dentist (Licensed)
Public Health Dental Hygiene Practitioner (PHDHP) (Certified)
Dental Hygienist (Licensed)
EFDA (Certified)
Dental Assistant
Student
Community Health Worker (Certified)
Community Health Worker
Water Operator (Certified)
None of the above/other
If you hold a license/certification, please choose the option that includes that.
Please choose your secondary position (optional)
Dentist (Licensed)
Public Health Dental Hygiene Practitioner (PHDHP) (Certified)
Dental Hygienist (Licensed)
EFDA (Certified)
Dental Assistant
Student
Community Health Worker (Certified)
Community Health Worker
Water Operator (Certified)
None of the above/other
If you hold a license/certification, please choose the option that includes that.
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