Fillable DENTAL ASSISTANT LICENSURE ... - State of Michigan - michigan

LARA/LDN-506 09/12 Michigan Department of Licensing and Regulatory Affairs Board of Dentistry P. O. Box 30670 Lansing Michigan 48909 517 335-0918 www. michigan*gov/healthlicense DENTAL ASSISTANT LICENSURE INSTRUCTIONS Authority P. A. 368 of 1978 as amended This form is for information only. NOTE It is your responsibility to have all required documentation sent to the Board of Dentistry. Questions regarding your...
Fill & Sign Online, Print, Email, Fax, or Download
Fill Online
  • Fill Online
  • eSign
  • eFax
  • Email
  • Add Annotation
  • Share
Fill Online
Rate This Form