Now Live: Easier Online License Applications!
LicensE, our new, online, self-guided occupational license application platform is now live! The list of licenses available via LicensE is available HERE. Starting on May 16, 2022, those applicants can apply at license.wi.gov.
LicensE is for new, initial applications only. To renew your license, click HERE. You should not use LicensE to renew your license at this time.
For additional information, please see the LicensE User Guides and Video page. Check back for updates, FAQs, and application tips.
License Information
Per
Wis. Stat. § 440.08 (2), the required renewal date for the Dentist credential is 09/30/odd years. Should you receive your initial credential in the months leading up to this date, you are still required to renew your license by the statutorily defined date.
CPR and AED must be current to practice dentistry.
Pre-Credential Education Information
Graduate from a dental school accredited by the American Dental Association Commission on Dental Accreditation.
- A foreign trained Dentist may qualify for a license if he or she submits to the Board evidence of one of the following, in addition, a foreign trained Dentist must submit the same information required of non‑foreign trained Dentists listed in Wis. Admin. Code. § DE 2.01(1)(a) to (d),(f) and (g):
- Having been awarded a DDS of DMD degree from an accredited dental school;
verification of having received a dental diploma, degree, or certificate from a full time, undergraduate supplemental dental education program of at least two academic years at an accredited dental school. The program must provide didactic and clinical education to the level of a DDS or DMD graduate.
Conscious Sedation
Dentists administering minimal sedation do not need to obtain a sedation permit from the Dentistry Examining Board. Dentists administering moderate or deep anesthesia or sedation must obtain a permit from the Board. Once attained, the conscious sedation permit is renewed automatically at the time of license renewal without further education.
Note to Conscious Sedation Training Providers
Anesthesia Record Keeping and Reporting
Anesthesia record keeping requirements are listed in Wis. Admin. Code §
DE 11.09(9). For
convenience, the following links provide a sample form and sample record from the American Dental Association (ADA) website: Adverse occurrences related to anesthesia administration reporting requirements are listed in Wis. Admin. Code §
DE 11.10. Form
2764 (below) may be used for reporting purposes.
Application for Licensure
| Form | Description |
|---|
|
512 | Credentialing Information for Dental Applicants
|
|
3217 | Application for Fee Reduction (If applying for a fee reduction, this form
must accompany the application for the credential.) |
| 1471 | Dentist Certificate of Professional Education (This form must be completed by your school and returned directly to the Department) |
|
2829 | Malpractice Suits or Claims Form (if applicable) |
|
3085 | Application for Predetermination
(Optional-Submit ONLY if you have been convicted of any felony, misdemeanor, or other violations of federal or state law in this state or any other and you desire a review of your conviction record before applying for a credential.) |
|
2252 | Convictions and Pending Charges |
|
3071 | Fax Payment Form |
Application for Certificate to Administer Anesthesia/Conscious Sedation
| Form | Description |
|---|
|
2759 | Application for Permit to Administer Anesthesia or Conscious Sedation
|
|
2758 | Anesthesia or Conscious Sedation Education Verification Form |
|
2764 | Report of Adverse Occurrences Related to Anesthesia Administration |
|
3071 | Fax Payment Form |
Application for Faculty License
| Form | Description |
|---|
2650
| Credentialing Information for Dental Faculty Applicants
|
| 2653 | Faculty Dentist Certification of Offer of Employment |
|
2252 | Convictions and Pending Charges |
|
2829 | Malpractice Suits or Claims Form (if applicable) |
|
3071 | Fax Payment Form |
Application for Temporary Permit to Practice Dentistry Without Compensation
| Form | Description |
|---|
| 2850 | Credentialing information for Dentistry Practice without Compensation Applicants
|
|
2759 | Application For Dental Permit to Administer Conscious Sedation |
|
2252 | Convictions and Pending Charges |
|
2829 | Malpractice Suits or Claims Form (if applicable) |
| 3071 | Fax Payment Form |
Profession Forms
| Form | Description |
|---|
|
1817 | Documentation of Training Delegable Procedures to Unlicensed Person (Dental Assistant Delegation Form)
|