Process

Submit the application for limited licensure for dentist/dental hygienist and the following items:

Transcripts from dental hygiene college or school or copy of diploma

1.  Licensure status in other states including disciplinary actions
2.  Proof of current CPR certification in basic life support with AED
3. Letter of intent to employ from employing agency
4. $105 licensure fee or fee waiver form if volunteering

Submit your application, supporting documentation, and applicable fee payment to the following address: