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Dentist - Application Forms

Application by Examination, New Graduate, and Endorsement for people licensed in other states
Form # Title/Description
512  Application for Dental License
2252 Convictions and Pending Charges 
2829 Malpractice Suits or Claims Form  (Only needed if applicable) 
1471  Dentist Certificate of Professional Education This form must be completed by your school and returned directly to the Department.
 
Application  for Certificate to Administer Anesthesia/Conscious Sedation
Form # Title/Description
2759 Application For Dental Permit to Administer Conscious Sedation 
2758  Conscious Sedation Provider School Verification Form This form is for course providers to verify courses already approved.
2763  Procedure for Reporting Adverse Occurrences Related to Anesthesia Administration
2764  Report of Adverse Occurrences Related to Anesthesia Administration 
 
Application for Faculty License
Form # Title/Description
2650  Application For Dental Faculty License
2252  Convictions and Pending Charges 
2829 Malpractice Suits or Claims Form  (Only needed if applicable) 
 
Application for Temporary Permit to Practice Dentistry Without Compensation
Form # Title/Description
2850  Application for Temporary Permit to Practice Dentistry Without Compensation
2252  Convictions and Pending Charges 
2829 Malpractice Suits or Claims Form   (Only needed if applicable) 
 
Profession Forms
Form # Title/Description
1817  Documentation of Training Delegable Procedures to Unlicensed Person Dental Assistant Delegation Form.

Other Information/Forms

Dentist - License Information