PAGD Mentors, Welcome to The Pennsylvania Academy of General Dentistry, Advocacy for Patients and Dentists

PAGD MENTORS

Become a PAGD Mentor to make yourself available to new dentists about to embark on their career in dentistry.

Professional Name:
I prefer to be called:
Work Address
Street:
City:
State:
Zip Code:
County:
Best Way To Be Contacted
Phone Number:
Business Website:
Email:
Facebook:
Dental School Attended:
Year Received Doctorate:
Pre-Professional School Attended:
Degree Received:
Type of Practice
Solo:
Group:
Types of Specialists Within Your Group:
Number of Years Practicing:
List the Dental Disciplines You Routinely Practice:
Dental Disciplines You are Currently Studying:
AGD Number:
Upload Photo:

By submitting this form I agree to be a volunteer mentor of the PAGD Mentor Program. I give permission to PAGD to list the information listed on this website (www.pagd.org). I will update this information annually and can decide to not participate at any time via written notice.