Faculty Dentist

To be considered eligible to apply for licensure as a faculty dentist, applicants must:

• Hold an active license dental license in good standing in another state or country.

• Have an offer of employment from an educational institution in Wisconsin.

• Hold current certification in Cardiopulmonary Resuscitation (CPR) and Automated External Defibrillator (AED) program completion though a program approved by the Wisconsin Department of Health Services.

1. Complete form 2650.

2. Email the form and supporting documents to dspscreddentistry@wisconsin.gov.

3. Submit a support ticket by choosing Request Support at LicensE.wi.gov confirming that the application form has been emailed. 

Required Documents:

• Certificate of Proficiency in Cardiopulmonary Resuscitation/AED

• National Practitioner Data Bank Report (NPDB)

• Form 2653: Certification of Offer of Employment

• Verification of active licensure issued by another state or jurisdiction of the United States or Canada.

Required if Applicable:

• Malpractice Suits Claims Form (Form 2829)

1. Once you application has been received, you will be emailed notification of any remaining requirements.

2. After all required documents have been received, the application will be sent to the dental board liaison for review. An appearance before the board is not required. 

3. Once a response is received for the board liaison, your application will be updated, and you will be notified of the determination made regarding your application for licensure.

Support Ticket
Submit a support ticket on LicensE and click "request support." Please provide as much detail as possible regarding your concern so we can work to answer your question with a one touch resolution. 

Call
608-266-2112

Email
dsps@wisconsin.gov

Office Hours
7:45am-4:30pm
Department of Safety and Professional Services
4822 Madison Yards Way
Madison, WI, 53705

Note: The in-person office does not process same day.