Refer to Georgia Law O.C.G.A § 43-11-41 and
Board Rule 150-7-.04
- *APPLICATION - Found on the board’s web-site (http://sos.georgia.gov/plb/dentistry/) under the link Online Services/Download Forms.
- *NOTARIZED APPLICATION: Completed application form accompanied by a fee of $3025.00. Your application will not be processed unless the fee and all supporting documents are received.
- *LICENSE VERIFICATION: Official licensure verifications for every dental license ever held, other than Georgia. Each letter must indicate the date of licensure, the licensure status (active, inactive, expired, or revoked, etc.) standing of license, any disciplinary charges made against you by the licensing board or by any other state agency, and the result of these actions. The applicant must provide a copy of the formal complaint/pleading, outcomes, and a personal written explanation for each instance of discipline. The verification must be submitted with your application IN THE ORIGINAL SEALED ENVELOPE FROM THE BOARD OF EACH LICENSING STATE, and must be dated within four months of Board receipt of your complete application packet.
- *DEGREE TRANSCRIPT: An Official Transcript which documents graduation with a D.D.S. or D.M.D. degree from a dental school which is accredited by the American Dental Association Commission on Dental Education. The transcript must be IN THE ORIGINAL SEALED ENVELOPE FROM THE COLLEGE. Graduates from a non-accredited school please see Rule 150-3-.04 and O.C.G.A.§ 43-11-40(a)(1)(A) and (B). *Note: All foreign trained applicants’ applications must be reviewed and approved by the board.
- *NATIONAL BOARD SCORES: National Board Scores from the ADA Joint Commission on National Dental examinations. The ADA (1-800-621-8099) will send a copy of National Board scores to state licensure boards only. If you ask the ADA to send our board a copy of your National Board scores, so indicate in your application packet. Please do not submit the National Board Certificate. Your scores must come directly from the ADA to the Board Office.
- *CLINICAL LICENSURE EXAMINATION:
Certification that the applicant has successfully completed with a passing score in each section, a clinical licensing examination in general dentistry conducted by a regional or state testing agency that meets the following criteria:
Such verification shall state that the examination included clinical testing on live patients in the following areas:
- Anonymity between candidate and examiners.
- Psychometrically valid procedures for standardization and calibration of the examiners.
- A post examination analysis of the scoring for single examination aberrations.
Such verification shall also include clinical testing on mannequin or model in the following areas:
- Periodontal clinical abilities testing.
- Completion of at least two of the following four areas:
- Class II Amalgam preparation and finish
- Cast Gold preparation and finish, Class II inlay, onlay, partial or full coverage crown
- Class II Composite preparation and finish
- Class III Composite preparation and finish
Additional clinical abilities testing modules successfully completed will be considered as substitutes where appropriate for the above requirements if those modules test a similar skill set.
If the examination completed did not require testing in the above listed modules, the application will be considered on an individual basis.
*JURISPRUDENCE EXAMINATION: Successful completion of the Jurisprudence Examination with a score of 75 or higher. The Jurisprudence Examination may be taken as an open book exam. The examination and “law and rules” governing the practice of dentistry in Georgia may be obtained on the Georgia Board of Dentistry website at
http://sos.georgia.gov/plb/dentistry. Score is only valid for one (1) year.
*NATIONAL PRACTITIONER DATA BANK: A National Practitioner Data Bank (NPDB) certified report of any pending or final disciplinary actions or malpractice actions against any license ever held by the applicant in any state.
All applicants must submit a NPDB report along with a completed application. (NPDB must be dated within four months). The
ONLY applicants exempted from the requirement of NPDB report submission are those applicants within 6 months of dental school graduation who have never been issued a dental license in any state or U.S. territory. The NPDB report
must be received in the ORIGINAL SEALED ENVELOPE FROM NPDB. Those applications that may have any disciplinary or malpractice case(s) (open & closed) will be considered for licensure on a case by case basis, after receipt of all required application materials. For each case, the applicant must submit: 1) a copy of the formal complaint pleadings filed by the plaintiff/complainant or State Regulatory Agency, 2) a copy of the final action, disposition, or settlement, 3) a personal explanation of the disciplinary action or the malpractice claim, and 4) any further information requested by the Board in separate communications. To obtain information (self-query) from the NPDB-HIPDB, please visit www.npdb-hipdb.com, scroll to the right side of the home page, and click
Perform a Self-Query. The self-query is $20.00, payable by credit card (VISA, MasterCard, Discover, or American Express). If you do not have Internet access, contact the Customer Service Center at 1-800-767-6732 from 8:30 a.m. to 6:00 p.m. Eastern Time (8:30 a.m. to 5:30 p.m. Fridays).
*CRIMINAL HISTORY INFORMATION:
If you have ever been summoned, arrested, taken into custody, indicted, convicted or tried for, or charged with, or pled guilty to, or pled nolo contendere to, a violation of any law or ordinance or the commission of any felony or misdemeanor (excluding minor traffic violations), (DWI & DUI are not minor traffic violations), or if you have been requested to appear before a prosecuting attorney or investigative agency in any matter
you must attach the court disposition. Although a conviction may have been expunged from the records by a court order, it nevertheless must be disclosed on your application. For each occurrence furnish a written statement giving the complete facts in your own words, including in the statement the date, name and nature of the offense, the name and locality of the court, and the disposition of each such matter.
*CPR: Submit a photocopy of your
current CPR certification pursuant to
Board Rule 150-3-.08.
*DEA REGISTRATION: Verification of applicant’s registration with the federal Drug Enforcement Administration (DEA), from the DEA, even if applicant is not currently registered with the DEA.
EMPLOYMENT AFFIDAVIT: An affidavit from the applicant stating employment for the five years
immediately preceding application: (A) the dates and locations where the applicant has practiced dentistry; and (B) that the applicant has been in full time clinical practice of a minimum of 1000 hours per year in the hands on treatment of patients.
Training programs do not qualify as full time clinical practice.
Please note that the practice requirement cannot be waived as it is required by law.
MALPRACTICE QUESTIONNAIRE: Complete one for each suit and attach the necessary documentation. (If not applicable, write N/A on the form sign, date, and return with application).
*COPY OF COURT DOCUMENT OR AFFIDAVIT explaining any discrepancies of the applicant’s name if documents submitted bear different name(s).[i.e. marriage certificate, divorce decree, legal name change] .
*TWO (2) REFERENCES: The reference forms must be mailed in with the application IN THE ORIGINAL SEALED ENVELOPE FROM THE REFERENCE.
- Endodontic clinical abilities testing access opening and root canal fill
- Prosthodontic clinical abilities testing of partial denture, full denture and implant case planning.
ALL dental licensure by credential applications MUST BE APPROVED by the Board./strong>