DEA Number - College of Dentistry » University of Florida



DEA NumberResidents only – Interns do not obtain DEA numberGo to on New ApplicationsClick on Begin Application ProcessForm 224 is pre-selected. Under Select One Business Activity drop down, select Practitioner.Click Begin1. General Information (Page 1)Type YOUR last nameType YOUR first nameAdditional Company Information type University of Florida, College of DentistryBusiness Address Line 1 type 1395 Center DriveAddress (Line 2) type YOUR department’s room numberCity GainesvilleState FLZip 32610Business Phone Number YOUR department’s phone numberBusiness Email Address YOUR ufl.edu or dental.ufl.edu accountContact Name: Dr. Carol StewartMailing Address: check the box (Check if same as business address)Click on Next - >1. Personal Information (Page 2)Do NOT enter Tax ID or SSN. LEAVE BOTH BOXES BLANKCheck box next to CERTIFICATION FOR FEE EXEMPTION-Government OnlyClick on Next - >1. Personal Information (Page 3 – Fee Exempt Details)Name of Fee Exempt Institution: UF College of DentistryCertifying Official Name: Dr. Carol StewartCertifying Official Title: Clinical DeanCertifying Official Phone Number: (352) 273-5800Check box next to I have read the above, and agreeClick on Next - >2. Business Activity/SchedulesDRUG SCHEDULES Check box next to Schedule II Narcotic. Do not check other boxes.Do not check box “…if you require order forms…”Enter your NPI if you have oneDegree Select your degree from the drop down boxBirthdate Enter your birthdateGraduation Year Select the year you graduated from dental schoolMedical/Professional School Enter the name of your dental schoolClick on Next - >3. State LicensesState License Number: Enter your license number or residency/intern permit numberState License State: Enter the stateExpire Date: Enter the expiration dateClick on Next - >4. Background InformationFill out sections 1-4 appropriatelyClick on Next - >Summary of InformationVerify that all information has been entered accurately. Make any necessary changes.*e-Signature: Your nameClick on Submit ApplicationMake a print out for your records ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download