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Pro Bono Dental Care Reporting Form
*Total value of services provided:
If applicable, please indicate the number of Medical Assistance patients for whom you provided free dental serices without submitting clainms to the Department of Public Welfare during the last 12 months:
Website questions or comments? Contact Jennifer Diamond McClure.
Pennsylvania Dental Association | 3501 North Front Street | P.O. Box 3341 | Harrisburg, PA | 17105
Phone: (717) 234-5941