Predetermination
Pursuant to
2017 Wisconsin Act 278, beginning August 1, 2018, prior to submitting an application for a credential, an individual may apply to the Department for a determination of whether the individual would be disqualified from obtaining the credential due to his or her conviction record. To apply for a predetermination, please fill out
Form #3085 and submit all required documentation specified on the form. Pursuant to
Wis. Stat. §
111.335(4)(e), the offenses or kinds of offenses that may result in a refusal, bar, or termination of licensure are published under Additional Resources on the left side of this page.
License Information
Fee Reduction
Pursuant to
2017 Wisconsin Act 319, beginning August 1, 2018, an applicant for an initial credential may apply for a reduction of the initial credential fee that is equal to 10% of the initial fee. Qualification is based on the federal adjusted gross income being at or below 180% of the federal poverty guideline prescribed for the applicant's family household size by the United States Department of Health and Human Services. To determine eligibility please visit the United States Department of Health and Human Services website at
https://aspe.hhs.gov/poverty-guidelines, prior to submitting
Form 3217.
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 | Application for Dental License |
|
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
(Submit ONLY if you have been convicted of any felony, misdemeanor, or other violations of federal, state, or local law, including municipal ordinances, in this state or any other) |
|
2252 | Convictions and Pending Charges |
|
3071 | Fax Payment Form |
Application for Certificate to Administer Anesthesia/Conscious Sedation
| Form | Description |
|---|
|
2759 | Application For Dental 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 | Application For Dental Faculty License |
| 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 | Application to Practice Dentistry without Compensation |
|
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)
|