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STATEMENT of SUPERVISING DENTIST for TEMPORARY DENTAL LICENSE APPLICANT I, ___, (hereinafter referred to as Dentist) am aware that ___, (hereinafter referred to as Applicant) has applied to the Nevada

How to fill out statement of supervising dentist

How to fill out statement of supervising dentist

1. To fill out a statement of supervising dentist, follow these steps:
2. Begin by including your personal information such as your name, contact details, and dental license number.
3. Next, provide information about the dental practice or institution where you are serving as a supervising dentist. This includes the name, address, and contact information.
4. Clearly state the purpose of the statement and mention that you are the supervising dentist overseeing the dental services provided at the practice.
5. Specify the dates or duration for which you have been acting as the supervising dentist.
6. Include details about the dental services provided, the number of patients treated, and the procedures performed during your supervision.
7. Sign and date the statement to certify its authenticity.
8. Make additional copies of the statement if required and keep a copy for your records.
9. Submit the filled-out statement of supervising dentist to the relevant authorities or as required by the dental board or regulatory body.

Who needs statement of supervising dentist?

1. A statement of supervising dentist is typically needed by dental students, dental hygienists, or dental assistants who are performing clinical procedures under the supervision of a licensed dentist.
2. It is also required by dental regulatory bodies or dental boards to ensure compliance with dental practice regulations and to maintain patient safety.

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What is statement of supervising dentist?

The statement of supervising dentist is a document confirming that a licensed dentist is overseeing the work of a dental hygienist or dental assistant.

Who is required to file statement of supervising dentist?

The supervising dentist is required to file the statement of supervising dentist.

How to fill out statement of supervising dentist?

The statement of supervising dentist can be filled out by providing the required information about the supervising dentist, dental hygienist or dental assistant, and the practice where they work.

What is the purpose of statement of supervising dentist?

The purpose of the statement of supervising dentist is to ensure that dental hygienists and dental assistants are working under the supervision of a licensed dentist.

What information must be reported on statement of supervising dentist?

The statement of supervising dentist must include information about the supervising dentist, dental hygienist or dental assistant, and the practice where they work.