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Dental Board Applications and Forms

Note: These files require the Adobe Acrobat Reader to view, if you don't have it, you can download it free.

Instruction Form for Obtaining a Kansas Dental / Dental Hygiene License by Credentials (82k pdf)
Application Form for Licensure by Credentials (78k pdf)

Application Form for License by Examination (95k pdf)
Instruction Form for License by Examination (88k pdf) 

Application Form for Reinstatement of License

Application Form for License to practice a Dental Specialty (16k pdf)
Instruction Form for License to practice a Dental Specialty (8k pdf)

Application Form for Level I Anesthesia Permit (70k pdf)

Application Form for Level II Anesthesia Permit (72k pdf)

Application Form for Extended Care Permit I & II (114k pdf)

Application Form for Approval of Continuing Education Course (8k pdf)
Continuing Education Log Form (39k pdf)

Application Form for Approval of Name for PA or LLC (63k pdf)

Application Form for Open Records Request (pdf) (Word)

Application for Request of Licensee Listing (82k pdf)

Application for Mobile Dental Facility or Portable Operation

Complaint Form (85k pdf)

Name and Address Change Form (11k pdf)
 

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Kansas Dental Board
900 SW Jackson, Room 564-S  -  Topeka, KS 66612-1230
Phone: (785) 296-6400  -  Fax: (785) 296-3116 

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