 |
|
PDF
forms require the Free
Adobe Reader to view or print.
Click the icon or the link above to download the free program. |
Click here to download the 2008-2009 Dental License and Dental Corporation Renewal Form.
If you have Level 3 (conscious sedation), Level 4 (general anesthesia), or facility permits, click here. You must download and print a form for each permit.
Before sending your renewal form to the Board office, make sure that you have done the following:
- Signed the renewal form (at the bottom of the CE form page).
- Made a copy of both sides of your current Healthcare Provider level CPR card to send with your renewal. Note: Level 3 and Level 4 sedation permit holders must submit a copy of the PALS or ACLS CPR card.
- Answered all questions and filled in all blanks. If the answer to a question is “none” or “not applicable”, please write “none” or “not applicable” or “n/a”. Incomplete renewals will be returned and charged a reprocessing fee of $25.
- Recorded your infection control CE course on the CE form.
- Recorded the appropriate number of CE hours on the CE form.
Reminder
- DO NOT send CE certificates or course documentation to the Board office.
- CE hours for dentists:
- If you were licensed before 2006 = 50 CE hours.
- If you were licensed in 2006 = 25 CE hours.
- If you were licensed in 2007 = 0 CE hours (simply write “Licensed in 2007” on the CE form).
- The Board can only accept the “Healthcare Provider “(or its equivalent, “CPR for the Professional Rescuer with AED”), PALS, or ACLS CPR courses. Note: Your CPR course can be counted towards your continuing education credits. The number of CE credits depends on the number of hours of instruction.
- The dental license renewal fee is $300. Be sure to include an additional $20 for each dental corporation that is listed on the renewal form. Failure to do so will result in an additional $25 reprocessing fee and your renewal form will be returned to you. Also, you must pay $80 for each sedation permit and facility permit that you have.
|
