234 CMR, § 4.05 - Initial Licensure as Limited License Full-time Faculty or Limited License Dental Intern

Pursuant to M.G.L. c. 112, § 45A, the Board may grant a limited license for an applicant to serve as a full-time member of a dental college faculty or as a limited license dental intern in a hospital or other institution maintained by the state, a county or municipality, or hospital or dental infirmary incorporated under the laws of the Commonwealth, provided that 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 as 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;

(3) Proof satisfactory to the Board that the applicant has received a diploma in dentistry from the faculty of a reputable dental college:

(a) Graduates of a dental program accredited by CODA or any Board-approved successor accrediting agency shall submit an original transcript with the college seal stating the degree granted and the date of issue, or a letter including the college's seal signed by the appropriate authority attesting to the applicant's degree and date of graduation.

(b) Graduates of non-CODA or foreign dental programs shall submit an original transcript, with college seal stating the date of issuance of a dental diploma. If the transcript is not in English, the applicant shall provide a certified translated copy of the original dental college transcript demonstrating the applicant received a dental degree.

(4) Proof satisfactory to the Board of employment as full-time faculty in a dental school accredited by CODA or as a dental intern in a hospital or other institution maintained by the state, a county or municipality, or hospital or dental infirmary incorporated under the laws of the Commonwealth.

(a) An applicant for a limited faculty license shall submit an original letter with the college seal confirming the applicant's status and dates of appointment as a full-time faculty member at a CODA-accredited dental school. The application shall also include the printed name, signature and license number of the applicant's supervising licensed dentist, who shall be in good standing with the Board.

(b) An applicant for a limited dental intern license shall submit an application for licensure stating the applicant's place(s) of employment and corresponding date(s) of appointment. The application shall also include the printed name, signature and license number of the applicant's supervising licensed dentist, whose license shall be in good standing.

(5) Documentation of continuing education in the following areas or the applicant's signed attestation that the applicant will within one year of initial licensure complete the following in accordance with 234 CMR 8.00: Continuing Education:

(a) A minimum of three CEUs in CDC Guidelines;

(b) A minimum of three CEUs in OSHA Standards;

(c) A minimum of six CEUs in treatment planning and diagnosis;

(d) A minimum of three CEUs in record-keeping;

(e) A minimum of two CEUs in risk management; and

(f) A minimum of three CEUs in pharmacology, with emphasis on prescription writing; or

(g) Evidence of enrollment in a CODA-accredited dental school that includes the areas of study included in 234 CMR 4.05(5)(a) through (f).

(6) Documentation of current BLS certification or CPR/AED certification;

(7) If the applicant has graduated from a dental school where the language of instruction (including textbooks) is not English, the applicant shall submit documentation the applicant has achieved a minimum passing score, as specified by the Board, on a Board-designated test of English proficiency;

(8) 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 reporting impairments that may affect the applicant's ability to practice dentistry;

(9) Certified letters of standing from all jurisdictions in which the applicant has ever been issued a license to practice dentistry including report of any past or pending disciplinary action or any pending complaints against the applicant;

(10) A practice history;

(11) An original report from the NPDB Self-query;

(12) A statement disclosing any and all disciplinary, civil or criminal action 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) Proof satisfactory to the Board of good moral character;

(14) Documentation of passing the Massachusetts Dental Ethics and Jurisprudence Examination or a Board-approved successor examination;

(15) A passport-size color photograph;

(16) 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

(17) 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

234 CMR, § 4.05

Amended by Mass Register Issue 1271, eff. 10/10/2014. Amended by Mass Register Issue 1363, eff. 4/20/2018.