Review:
New Applicant - Dental Therapy tab
Video Tutorials page
These video tutorials have been created by Board staff to provide assistance to applicants for licensure in a helpful visual format.
Pre-Application Process and Criminal Background Checks
Applying for a Dental Therapy License
Collaborative Management Agreements
Click here to register, edit, or dissolve your CMA
The forms below may be used for your own record keeping:
Advanced Dental Therapy Certification
Advanced Dental Therapy Certification Process
Recordkeeping Forms:
1 Adult / Posterior Amalgam Class II (OR) Adult / Posterior Composite Class II
2 Adult Anterior Composite Class III
3 Deciduous Molar Pulpotomy Access and Completion
4 Deciduous or Permanent Molar Stainless Steel Crown Completion
5 Extraction of Deciduous Tooth
Click here for information on the dental therapy examination.
Application Forms
Resident Dental Provider Application Form
Application for Licensure by Exam
Advanced Dental Therapy Certification Application Form
Application forms and information are available at New Applicant -Dental Therapy
Licensure to Practice as a Resident Provider
Non-refundable Fee: $88.25 (Application fee: $55, Background check fee: $33.25)
Licensure by Exam to Practice Dental Therapy
Non-refundable Fee: $253.25 (Application fee: $100, Background check fee: $33.25, Initial fee: $120)
Advance Dental Therapy Certification Application - $100
Must be renewed. Renew biennially according to birth month and year.