License to Practice Dentistry  with Examination Application Packet  (.PDF)

License to Practice Dentistry without Examination Application Packet  (.PDF)

Application Packet for:  (.PDF)

• Moderate Sedation Permit
• Moderate Sedation with Parenteral Agents Permit
• General Anesthesia & Deep Sedation Permit

Expired Credential Reactivation Application  (.PDF) Use this application if your license has been expired for less than three years. If your license has been expired for more than three years, you MUST complete a new License to Practice Dentistry application.

Dental Assistant Sealant Varnish Endorsement  (.PDF) - (For dental assistants providing dental sealant and fluoride varnish treatments in school based programs. This endorsement is NOT required for dental assistants.)

Expanded Function Dental Auxiliary

Expanded Function Dental Auxiliary License Application

Schools Expanded Function Dental Auxiliary Education Program

Expanded Function Dental Auxiliary (EFDA) Education Program Application Packet - (For schools to provide EFDA education.)

Expanded Function Dental Auxiliary (EFDA) Curriculum Guideline

 Please Note:  Before submitting these forms please confirm that you have met all qualifications listed on the License Information  page of this site.  All application fees are nonrefundable.  If you need assistance on determining your eligibility for licensure please feel free to contact us.

 

 

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