Secure.in.gov

INDIANA STATE BOARD OF DENTISTRYPROFESSIONAL LICENSING AGENCY402 West Washington Street, Room W072Indianapolis, Indiana 46204Telephone: (317) 234-2054Email: pla8@pla.in.govwww.pla.IN.govAPPLICATION FOR A LIMITED DENTAL . RESIDENCY . PERMIT *Your Social Security number is requested by the agency in accordance with IC 4-1-8-1. ................
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