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Summary Sheet for the Required Continuing Dental Education Hours (Add more rows as necessary)
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TypeCourse TitleContent of CourseRecognized Provider's NameCourse PeriodVerification Document Included (P)No. of CE/CME Hours Earned
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Start DateEnd Date
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Implant Continuum Courses (Minimum 200 CE hours)o
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Individual courses used for completing the remainder of CE hourso
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Sum of Hours
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Name:Date:
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Signarure:
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