Get the free Alaska Dental Application for Individuals and Families - Aetna

Coverage is provided by Aetna Life Insurance Company. Instructions: Alaska Dental Application for Individuals and Families ? Application must be completed by the applicant in blue or black ink. Please

How to fill out alaska dental application for

How to fill out Alaska dental application form:

1. Start by obtaining the Alaska dental application form: You can either download it from the Alaska Dental Society website or pick up a physical copy from their office.
2. Fill out personal information: Begin by completing the personal information section, including your full name, address, contact number, and email.
3. Provide dental license details: If you are a licensed dentist, you will need to enter your license number and expiration date. If you are applying for a license, you can skip this step.
4. Indicate your education and training: Fill in the details of your dental education, including the name of the dental school you attended, the dates of your attendance, and any additional postgraduate training you have completed.
5. Submit professional experience: List your work experience in the dental field, starting with your most recent job. Include the name of the employer, dates of employment, and a brief description of your role and responsibilities.
6. Mention any disciplinary actions: If you have ever been subject to disciplinary action or had your dental license suspended or revoked, disclose that information here. Be honest and provide all necessary details.
7. Provide information about liability claims: If you have ever been involved in malpractice claims or lawsuits, record the details, including the date, case number, and outcome.
8. Sign and date the application: Read the declaration at the end of the form carefully, signifying that all information provided is true and accurate to the best of your knowledge. Add the current date below your signature.

Who needs an Alaska dental application form?

1. Dentists: Licensed dentists in Alaska who wish to obtain or renew their dental license need to fill out the Alaska dental application form.
2. Dental graduates: Individuals who have recently graduated from an accredited dental school and are seeking to practice dentistry in Alaska need to complete the application to apply for a dental license.
3. Dentists with disciplinary history: Dentists who have faced disciplinary actions or have had their licenses suspended or revoked in the past must also fill out the Alaska dental application form, disclosing such information.

Note: It is essential to review the specific requirements and instructions provided with the application form to ensure accurate completion.

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What is alaska dental application for?

The Alaska dental application is used for obtaining a dental license in the state of Alaska.

Who is required to file alaska dental application for?

Dentists who wish to practice dentistry in Alaska are required to file the Alaska dental application.

How to fill out alaska dental application for?

The Alaska dental application can be filled out online on the Alaska Board of Dental Examiners website or downloaded and submitted via mail.

What is the purpose of alaska dental application for?

The purpose of the Alaska dental application is to ensure that dentists meet the necessary qualifications and requirements to practice dentistry in Alaska.

What information must be reported on alaska dental application for?

The Alaska dental application requires information such as education background, work experience, references, and proof of passing the required exams.