234 CMR, § 4.04 - Initial Dentist Licensure by Credentials
The Board may grant a license by credentials, without further professional examination, to a dentist currently licensed in another jurisdiction, provided the applicant is of good moral character, has met all eligibility requirements and has submitted the following information to the Board:
(1) An accurate, complete and
signed application on forms specified by the Board for that purpose;
(2) Payment of a non-refundable licensing and
application fee as determined by the Executive Office of Administration and
Finance, unless waived in accordance with M.G.L. c. 112, § IB;
(3) An original transcript with the college
seal stating the degree granted and the date of issue from a CODA-accredited
dental school or any successor accrediting agency approved by the Board, or a
letter including the college's seal signed by the appropriate authority
attesting to the applicant's degree and date of graduation;
(4) A physician's statement made after an
examination conducted within one year of the date of application, attesting to
the health of the applicant and to any impairments that may affect the ability
of the applicant to practice dentistry;
(5) Proof satisfactory to the Board of a
minimum of five years of practice in dentistry or dental education immediately
preceding the application for licensure by credentials. An applicant may
include private practice; the practice of dentistry in the armed forces;
federal, state, and municipal programs; and intern and residency programs as
part of this five year dental practice requirement;
(6) Proof satisfactory to the Board that the
applicant is currently licensed and in good standing in another jurisdiction
based on passing a Board-approved examination;
(7) Documentation of a passing score on each
of the following exams:
(a) Parts I and II of
the ADA National Board Examination;
(b) The CDCA or other state or regional
examination approved by the Board; and
(c) Massachusetts Dental Ethics and
Jurisprudence Examination or a Board-approved successor examination.
(8) Certified letters of standing
from all jurisdictions in which the applicant has been issued a license to
practice dentistry attesting to the standing of the applicant's license,
including report of any past or pending disciplinary action, or any pending
complaints against the applicant;
(9) Letters of endorsement from two licensed
dentists who are in good standing and familiar with the applicant and his or
her practice of dentistry which attest to the applicant's professional
competency and good moral character;
(10) Original report from the NPDB
Self-query;
(11) Documentation of
current BLS certification or CPR/AED certification, except an applicant
applying for an individual anesthesia permit shall provide documentation that
complies with
234 CMR 6.00:
Administration of Anesthesia and Sedation;
(12) A statement disclosing any and all
disciplinary action, civil or criminal action, or restriction of privileges
taken or filed against the applicant at any time after reaching the age of
majority and prior to the date of application, with supporting documentation as
the Board may require;
(13) A
passport-size color photograph;
(14) Proof satisfactory to the Board of good
moral character;
(15) An
attestation, signed under pains and penalties of perjury, that the applicant
has complied with all state tax laws pursuant to M.G.L. c. 62C, § 49A and
child support laws pursuant to M.G.L. c. 119A, § 16(a); and
(16) Proof satisfactory to the Board of
completion of training required pursuant to M.G.L. c. 94C, § 18(e) as a
condition precedent for obtaining licensure.
Notes
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