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Dentist - Application Forms

Application by Examination , New Graduate
Form # Title/Description
512  Application for Dental License
2252  Convictions and Pending Charges if applicable
1471  Dentist Certificate of Professional Education 
This form must be completed by your school and returned directly to the Dept.
74  Instructions to Examination Applicants For Dentist Licensure 
 
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 Endorsement For people licensed in other states
Form # Title/Description
512  Application for Dental License 
2252  Convictions and Pending Charges If applicable
1471  Dentist Certificate of Professional Education
This form must be completed by your school and returned directly to the Dept.
1182  Instructions to Endorsement Applicants for Dentist Licensure 
 
Application for Faculty License
Form # Title/Description
2650  Application For Dental Faculty License
2252  Convictions and Pending Charges If applicable
2651  Instructions to Applicants For Dental Faculty Licensure 
 
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 If applicable
2851  Instructions for completing Application for Temporary Permit to Practice Dentistry Without Compensation
 
Profession Forms
Form # Title/Description
1817  Documentation of Training Delegable Procedures to Unlicensed Person Dental Assistant Delegation Form

Other Information/Forms

Dentist - License Information