DPH: Requirements for Provisional Licensure for Faculty of Connecticut Dental Schools

Requirements for Provisional Licensure for Faculty of Connecticut Dental Schools

 

Before applying for licensure, please familiarize yourself with the general licensing policies.

 

In order to qualify for provisional licensure, an applicant must be a full-time faculty member of a Connecticut dental school.  Once issued, the licensee is authorized to practice solely within the school of dentistry or a hospital affiliated with the dental school.  The applicant must:

 

Be a graduate of a dental school located outside the United States and possess exceptional qualifications as determined by the Connecticut State Dental Commission; or

 

hold a current, unrestricted dental license in another state of the United States and possess exceptional qualifications as determined by the Connecticut State Dental Commission; or

The Commission considers many factors when determining exceptional qualifications including, but not limited to, academic achievement, postgraduate training, examination history and board certification.  Each applicant is reviewed individually prior to the Commission's determination. 

Please note that the Commission meets quarterly and all applications must be complete 14 business days prior to the meeting in order to place the application on the meeting agenda.  Incomplete applications will not be placed on the agenda until the next regularly scheduled meeting. 

 

DOCUMENTATION REQUIREMENTS

 

The following documents should be forwarded directly to this office:

 

A completed, notarized application with photo and fee in the form of a bank check or money order for $565.00 payable to, “Treasurer, State of Connecticut”;

 

A separate certified bank check or money order in the amount of $4.75 made payable to, "Treasurer, State of CT".  This payment covers the Department's cost for querying the National Practitioner Data Bank (NPDB).

 

Please do not combine the above two (2) payments into one single payment.  Such a payment cannot be processed and will delay the Department's processing of the application.

 

Official transcript's of dental education, verifying the award of the degree in dentistry (note, transcripts arriving in a non-English language must be translated in accordance with procedures established by this office.  Instructions for obtaining a translation will be provided upon receipt of the transcript from the foreign institution);

 

If applicable, an official report of National Board scores sent directly to this office;

 

If applicable, an official report of successful completion of one of the following  clinical performance examinations:

 

North East Regional Board of Dental Examiners, Inc.;

 

Southern Regional Testing Agency;

 

Central Regional Dental Testing Service;

 

Western Regional Examining Board;

 

If applicable, verification of all licenses held by the applicant (current or expired)  from each state or territory in which the applicant is or has ever been licensed.   Most states charge a fee for completion of the form.  Please contact each state or territory for fee information.

 

A letter directly from the school of dentistry confirming full-time appointment and indicating why the Commission should consider you as exceptionally qualified.  

 

All supporting documentation should be sent to:

 

Connecticut Department of Public Health

Dental Licensure

410 Capitol Ave., MS #12 APP

P.O. Box 340308

Hartford, CT 06134

Phone: (860) 509-7603

Fax: (860) 707-1929

Email: dph.dentalteam@ct.gov

 





Content Last Modified on 6/19/2013 11:48:04 AM