A24. 

Please refer to Board Rule 150-3-.05

  • *REINSTATEMENT 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 accompanied by a fee of $375. If reinstatement is granted, the license will be required to be renewed by the last day of December in ODD numbered years, regardless of when you were reinstated.
  • *LICENSE VERIFICATION: Official licensure verification(s) for every dental license ever held, other than Georgia. Each letter must indicate the date of licensure, the licensure status (active, inactive, expired, 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. You should call each state board about fees for these services. 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.
  • *NATIONAL PRACTIONER 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 of receipt of your application). 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. 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 fee 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).
  • *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]
  • *CPR: Submit a photocopy of your current CPR certification pursuant toBoard Rule 150-5-.04
  • *RESUME OR CURRICULUM VITATE: List chronologically all employment, hospital privileges, specialty training and all other experience in the practice of dentistry/dental hygiene. Include names, beginning and ending dates, and locations, where applicable. Explain any intervals where you were not in training or practicing dentistry.
  • *FOUR (4) REFERENCES: The reference forms must be mailed in with the application IN THE ORIGINAL SEALED ENVELOPE FROM THE REFERENCE.
  • *CONTINUING EDUCATION: All licensees are required to have continuing education credits in order to maintain a license in the State of Georgia. Hygienists must submit proof of 22 hours of Board approved continuing education obtained within the last two (2) years from the date of submission of application for Board approval. Note: Once reinstated an additional 22 hours for hygienists must be obtained for the upcoming renewal period. The hours submitted for reinstatement of license cannot be used to fulfill the requirements for an upcoming license renewal period.
  • *MALPRACTICE QUESTIONNAIRE: Be sure to 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).

Reminder: It is against the law to practice dentistry/dental hygiene with a lapsed/expired license. An individual who continues to practice with a lapsed/expired license is subject to a fine and disciplinary action.

For any reinstatement application citing problems, (not having CE during last biennial renewal period, convictions, disciplinary action in other states, impairment, etc.) the licensee will be scheduled to a meeting with the Licensure Overview Committee and the following guidelines may apply:

Guidelines for Reinstatement

No Clinical Practice Reassessment of Skills (1 week) Remediation and Reassessment of Skills Letter of Competency CRDTS Exam
3 – <5 yrs X   X  
5 yrs - <10 yrs X X X X
10 yrs - +   X X X

For licensees that state that they have not been practicing without a license since the date that the license lapsed are reinstated without a consent order. However, the following guidelines may apply:

Guidelines for Reinstatement

No Clinical Practice Reassessment of Skills (1 week) Remediation and Reassessment of Skills Letter of Competency CRDTS Exam
3 – <5 yrs X   X  
5 yrs - <10 yrs X X X X
10 yrs - +   X X X

For licensees that state that they have been practicing without a license since the date that the license lapsed are reinstated and the matter is referred to Legal Services to send a public consent order citing the dates of the unlicensed practice with a $1,000 fine to be paid within 120 days of the effective date of the order, 3 years probation, completion the Law Ethics and Professionalism (LEAP) course within one year of the effective date of the order, 5 hours CE in Risk Management within one year of the effective date. A letter of concern is to be mailed to all employers of hygienists with a lapsed license concerning aiding and abetting unlicensed practice.

The board also allows reinstatement consent orders that have been signed by the licensee and returned to the board office to be accepted upon receipt, with the Executive Director signing for the Board President.

If reinstatement is granted, the license will be required to be renewed by the last day of December in ODD numbered years, regardless of when the license is reinstated.

The implications of a licensee practicing without a license are far-reaching. Employees/associates working with an unlicensed person could be subject to disciplinary action for aiding & abetting unlicensed practice; Medicaid & Medicare charges during the unlicensed period may be subject to denial or reimbursement; malpractice providers may not cover the individual during the unlicensed period.

All reinstatement applications must be reviewed and approved by the Board.