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Complaint Form:

• Complaint Form

Licensing Applications:

• License by Credentials
• License by Examination
• Reinstatement of License
• License to practice a Dental Specialty (Application)
• License to practice a Dental Specialty (Instructions)
• Special Volunteer Dental License
• Return license from retired/disabled status to active status
• Mobile Dental Facility or Portable Operation

Extended Care Permits:

• Extended Care Permit I
• Extended Care Permit II
• Extended Care Permit III
• Extended Care Permit: Change of Sponsoring Dentist

General Forms:

• Verification of Licensure to Another State
• Approval of Continuing Education Course
• Approval of Name for PA or LLC
• Open Records Request
• Request of Licensee Listing
• Dental Externships
• Dental Hygiene Exterships
• Name and Address Change Form
• Dental Office Administrative Services Provider Registration

Anesthesia Permits:

• Level I Anesthesia Permit Application
• Level II Anesthesia Permit Application
• Level III Anesthesia Permit Application

Course Approval for Level I & II Anesthesia Permits:

• Level I Anesthesia Course Approval form for Adults
• Level I Anesthesia Course Approval form for Children 12 & Under
• Level II Anesthesia Course Approval form for Adults
• Level II Anesthesia Course Approval form for Children 12 & Under

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