Board of Dentistry 1600 SW 4th Avenue Suite 770 Portland, OR - oregon-2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the 'Provider Name' in the designated field. This should be the full business name or individual’s name.
3. Next, input the 'Business Phone No.' which will be displayed on the Board’s website.
4. Fill in your 'Mailing Address'. Remember, this address is public record and will also appear on the Board’s site.
5. Select your 'Organization Type' from the provided options to categorize your application correctly.
6. Enter the 'CE Coordinator’s Name', who will manage your Continuing Education program and serve as a primary contact.
7. If different from your business phone number, provide the 'CE Coordinator’s Phone No.' for direct communication.
8. Attach a resume or CV for each instructor under 'Instructor’s Education/Training'. If applicable, include a recent catalog of courses offered.
9. Review all entries for accuracy before submitting. Once complete, return the application along with any attachments to the Oregon Board of Dentistry at the specified address.

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