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  CONTACT INFORMATION  
 
 
Salutation*
First Name*
Last Name*
Address*
 
City*
State*
Zip*
Phone 1*
Phone 2
 
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  PROFESSIONAL INFORMATION  
 
 
Position*
general dentist
specialist-endodontist
specialist-oral surgeon
specialist-orthodontist
specialist-pedodontist
specialist-periodontist
specialist-prosthodontist

School Degree Year

States licensed to practice
               

Professional Experience Summary
Please provide us with a brief summary of your dental field experience

(Maximum characters: 250)      characters left.

Seeking the following work opportunities*

Locum Tenens / Temporary Work
Associate Position
Partnership Position
Contract Work (long-term)

Skills & Clinical Preferences

Select all in which you are specifically comfortable
Routine Fillings
Crown & Bridge
Treatment Planning
Prophylaxes
Scaling & Root Planing
Hygiene Exams
Simple Extractions
Surgical Extractions
Non-Molar Endodontics
Molar Endodontics
Dentures
Invisalign
Cerec
Implant Crown Restoration
Implants
Fast Pace Office
Solo Provider Office
Multi-Provider Office
Children
Adult Patients
Geriatric-Elderly Patients
Medicaid
Public Health
Prisons-Corrections
Right-Handed Operatory
Left-Handed Operatory

Work Exceptions

Select all in which you are not comfortable
NO Routine Fillings
NO Crown & Bridge
NO Treatment Planning
NO Prophylaxes
NO Scaling & Root Planing
NO Hygiene Exams
NO Simple Extractions
NO Surgical Extractions
NO Non-Molar Endodontics
NO Molar Endodontics
NO Dentures
NO Invisalign
NO Cerec
NO Implant Crown Restoration
NO Implants
NO Fast Pace Office
NO Solo Provider Office
NO Multi-Provider Office
NO Children
NO Adult Patients
NO Geriatric-Elderly Patients
NO Medicaid
NO Public Health
NO Prisons-Corrections

Days available for contract or locum tenens work
Mon Tue Wed Thu Fri Sat/Sun

Where do you seek to work?
Provide the areas within the U.S. (please include states), and any travel parameters for locum tenens assignments or relocation plans.

(Maximum characters: 250)      characters left.

Clinical areas in which you work

general dentistry
endodontics
oral surgery
orthodontics
pedodontics
periodontics
prosthodontics


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