DPH: Dentist Licensure Reinstatement of a Lapsed License

Dentist Licensure Reinstatement of a Lapsed License

 

An applicant for reinstatement of a Connecticut license that has lapsed due to nonrenewal shall provide the following documentation:

 

A completed, notarized application with photo and fee in the amount of $565.00 in the form of a certified bank check or money order 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.

 

The applicant’s current curriculum vitae (CV) including a synopsis of professional activity since completion of dental school;

 

Verification of any out-of-state license held, current or expired, submitted directly to this office from the source.  Please contact the state prior to submitting a request as most states charge a fee for completion of the form;

 

Verification from the appropriate authority confirming your most recent employment; including dates and an overall evaluation of your ability to practice dentistry with reasonable skill and safety.  If you are in private practice, a letter from another dentist or physician with whom you have referred patients.  Such letter shall indicate dates of the referral relationship and an evaluation of your ability to practice dentistry with reasonable skill and safety; and

 

Verification of completion of 12 hours of continuing education (CE) within the one year period immediately preceding application for reinstatement.

 

Please note that an application from a dentist who has been out of the clinical practice of dentistry for longer than six (6) months is referred to the Connecticut State Dental Commission for the that body's recommendation regarding the applicant's eligibility for reinstatement.   The Commission meets quarterly.

 

All supporting documents should be mailed directly from the source to:

 

Connecticut Department of Public Health

Dental Licensing

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 1/5/2016 11:22:38 AM