007.33.22 Ark. Code R. § 020 - XXV: Licensure Fees
Article
XXV:
Fees
A. Initial
License/Permit
1. Dental License by
Examination $150
2. Dental License
by Credentials/Reciprocity $1,000
3. Dental Specialty License $300
4. Collaborative Care Permit for Dentists
$500
5. Hygiene License by
Examination $100
6. Hygiene License
by Credentials/Reciprocity $350
7.
Collaborative Care Permit I for Hygienists $100
8. Collaborative Care Permit II for
Hygienists $150
9. Corporation
Registration $25
10. General/Deep
Sedation Permit (Dentist) $500
11.
Moderate Sedation Permit (Dentist) $150
12. Local Anesthesia Permit (Hygienist)
$25
13. Mobile Dental Facility
Permit $5,000
14. Exam and
Licensing for Dental Assistants $75
B. Renewal
15. Dentist $300
16. Corporation Registration $10
17. Sedation Permit (Dentists) $80
18. Dental Hygienists $100
19. Reinstatement for Dentists and Hygienists
$200 plus renewal fee
20. Dental
Assistant $50
C. Other
21. Wall Certificate Remake for dentists
& hygienists $25
22. NSF
(returned) check fee $25
23.
Background checks $38.50
D. Fee Waiver
1. Pursuant to Act 725 of 2021, an applicant
may receive a waiver of the initial licensure fee, if eligible. Eligible
applicants are applicants who:
1) Are
receiving assistance through the Arkansas, or current state of residence
equivalent, Medicaid Program, the Supplemental Nutrition Assistance Program
(SNAP), the Special Supplemental Nutrition Program for Women, Infants, and
Children (SSNP), the Temporary Assistance for Needy Families Program (TEA), or
the Lifeline Assistance Program (LAP);
2) Were approved for unemployment within the
last twelve (12) months; or
3) Have
an income that does not exceed two hundred percent (200%) of the federal
poverty income guidelines.
2. Applicants shall provide documentation
showing their receipt of benefits from the appropriate State Agency.
1) For Medicaid, SNAP, SSNP, TEA, or LAP,
documentation from the Arkansas Department of Human Services (DHS), or current
state of residence equivalent agency;
2) For unemployment benefits approval in the
last twelve (12) months, the Arkansas Department of Workforce Services, or
current state of residence equivalent agency; or
3) For proof of income, copies of all United
States Internal Revenue Service Forms indicating applicant's total personal
income for the most recent tax year e.g., "W2," "1099," etc.
3. Applicants shall attest that
the documentation provided under subsection 2. is a true and correct copy and
fraudulent or fraudulently obtained documentation shall be grounds for denial
or revocation of license.
Notes
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