Initial Applications
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| Dentist (by NERB examination) |
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| Dentist (by waiver of clinical examination) |
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| Dentist - Limited Dental - Graduate of U.S. or Canadian Dental School |
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| Dentist - Limited Dental - Graduate of Foreign Dental School |
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| Dentist & Dental Hygienist- Teacher |
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| Dentist - Dental Pediatric Fellow |
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| Dental Hygienist (by NERB examination) |
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| Dental Hygienist (by waiver of clinical examination) |
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| Dental Radiation Technologist - (by waiver) |
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| Dental Radiation Technologist - (by examination) |
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| Qualified Dental Assistant - General |
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| Qualified Dental Assistant - Ortho |
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| Dentist Volunteer Application |
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| Dental Hygienist Volunteer Application |
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| Retired Volunteer Application |
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| Dentist and Dental Auxiliary Personnel Volunteer application |
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Reactivation/Reinstatement
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| Reactivation (Dentist or Dental Hygienist or Teacher) |
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| Reinstatement (Dentist or Dental Hygienist or Teacher) |
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| Reinstatement Application (Dental Radiation Technologist) |
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| Reinstatement Application of Expired 2013 (Dental Radiation Technologist) |
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Renewals
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Dentist |
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| Dental Hygienist |
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| Dental Radiation Technologist |
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| Application for Recognition as a Specialist |
| Application for Recognition as a Specialist |
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Complaint
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| Complaint Form |
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| Sedation Permits |
| Instructions for Anesthesia and Sedation Application |
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| Application for General Anesthesia & Parenteral Sedation Evaluators |
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| Application for Initial Anesthesia and Sedation Permits and Certificates |
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| Conversion- General Anesthesia/Parenteral Sedation Class II & III |
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| Conversion- Parenteral Sedation Permit Class II- ADD'L APP |
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Miscellaneous Forms
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Photo Affidavit- Dental Radiation Technologist
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| Change of Information (name, address, etc.) |
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| Application for Corporate Name |
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Drug Dispensing Application Form
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Dental Hygiene Waiver of General Supervision
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| Application to Administer Local Anesthesia by Infiltration |
| Applicant recognized to administer local anesthesia in another state |
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Applicant not recognized to administer local anesthesia in another state
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Download
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