Dentist

ANNOUNCEMENT:

The new system launched on August 22, 2016, all applications and renewals will need to be completed online.  The Board no longer accepts paper applications or paper checks since the new elicensing system is active.

To learn more about the licensure process, select the type of license you wish to apply for from the list of professions below. The Board has made every effort to include the information you need to apply for licensure on this website.  If you have questions or concerns about the licensure process, contact us at licensing@den.ohio.gov or call 614-466-2580 and speak with our licensing coordinator.

Please provide the necessary information/documentation required for processing your license application. You will be notified if any information/documentation is missing or not accepted.  Please allow up to 20 calendar days to process a complete application.

Dental License

License Requirements:  Ohio Revised Code 4715.10  

Before You Start: Make sure you have the following items or the application will not allow you to advance. All applications must be complete before submission.

Notification:  Once you register and start your online application, you will need to select the application (Dentist) and then the application type:  
Examination -
If you have ever taken and passed an accepted Regional Board examination (NERB/CDCA, SRTA, CRDTS or WREB), then you must select Examination regardless of whether you have an out-of-state-license.
Out-of-State - Reciprocity - If you have never successfully passed one of the accepted Regional Board examinations (NERB/CDCA, SRTA, CRDTS or WREB), and you currently possess a license in good standing from another state for at least five (5) years immediately preceding this application.
Residency - You must have completed a dental residency program accredited or approved by the Commission on Dental Accreditation and administered by an accredited dental college or hospital in lieu of taking or passing an accepted Regional Board examination.  

eLicense Ohio Portal -Apply Online 

Fee: Even Year - $454.00
Odd Year - $267.00
Renewal - $312.00 / Late Fee - 127.00
**Please note: It does not matter when your license is first issued. You will be required to renew by the December 31 of the odd year. That is why there are two different fees depending on when you apply.**

Mailing / Public Address: The Address should be the same for both, and should be your primary practice address. If you do not have a practice location yet, then it should be your home address.  Only the city and state show up on the public look-up. 
Employment History-  Additional Office Locations and/or prior employment 
Education History- Type "Other" to enter education institutions that are not found. 
Background Questions 

Criminal Records Check
– Refer to Ohio Revised Code 4715-4-01

Required Uploads: 
Identification Photo: Must be in color, Forward facing, Shoulders and above. 

Hepatitis B Immunity: 
            I. Vaccination record showing all three (3) hepatitis B shots dates, OR 
            II. A Positive/ Reactive/ >10 hepatitis surface antibodies titer, OR 
            III.  At the very Least we will accept proof that the first and second shots were administered, and the third shot (full date) is scheduled on a doctor's letterhead, script pad or appointment reminder. 
           IV. Hepatitis B Waiver Form

Medical Report- Completed by a Physician Assistant, or Nurse Practitioner

Jurisprudence Exam - This is an exam over the Dental Practice Act 
Dental Practice Act, 2017
Jurisprudence Exam
Answer Sheet and Notary page- These are the two documents you will upload. 

Proof of being a Graduate of an accredited dental college- the following will be accepted:
I. Transcripts indicating graduation date and degree received, OR
II. 
Certification of Dental School: - signed and sealed after graduation date, OR 
III.  A certification letter from school signed and sealed after graduation date. 

Joint Commission on National Dental Examinations (JCNDE) Score Card Part I and II
- If you need this document please contact the JCNDE at 312-440-2678

Proof of one of the following requirements:
I. Passed an accepted Regional Board Exam, OR
II. Possess a license in good standing from another state and have actively engaged in the legal and reputable practice of dentistry for five years immediately preceding application – (Certification/Verification letter from State Dental Board), OR
III. Have successfully completed a dental residency program accredited or approved by the Commission on Dental Accreditation (CODA) and administered by an accredited dental college or hospital- Proof of Residency/ PGY1 and Copy of Certificate of Completion.  

Valid Credit Card (MasterCard or Visa)

Dental Licensure for Graduates of an Unaccredited Dental College Outside the United States

License Requirements:  Ohio Administrative Code 4715-18-01  http://codes.ohio.gov/oac/4715-18-01

Before You Start: Make sure you have the following items or the application will not allow you to advance. All applications must be complete before submission.

eLicense Ohio Portal - Link to the eLicense Portal to apply
Fee: Even Year - $454.00
Odd Year - $267.00
Renewal - $312.00 / Late Fee - 127.00

Notification:  Once you register and start your online application, you will need to select the application and then the application type for Unaccredited College Outside of USA.

  • Certification of Dental School: - Proof  of graduation from a Commission on Dental Accreditation accredited Dental College.  We will accept the following: 
  • Official Transcripts with graduation date;
  • Certificate of Dental School-signed after graduation date (link provided); or 
  • A Letter from school with Seal-signed after graduation date 
  • Notarized Transcript and/or Educational Credentials in English Translation
  • Proof of completing a 2 year GPR or AEGD program from an accredited dental school  
  • TOEFL Scores, passing is 75% or higher
  • National Board Score Card - If you need this document, please contact the National Board at 312-440-2678.
  • Regional Board Exam Results with scores if you are applying via Examination.
  • Out-of-state License Certification if you have never taken any Regional Board examination.
  • Supporting documentation for any affirmative answers related to Background Questions - This should include a personal detailed summary of the situation and any supporting documentation (ex. Medical records and/or court documents indicating the charges and disposition).  
  • Medical Report completed within six months of application.
  • Proof of Hepatitis B immunity  - This should be an immunization record showing proof of all three shot dates completed or a positive Hepatitis B antibodies titer.
  • Jurisprudence Exam - You will need to upload only the completed answer sheet with notary section
    Dental Practice Act, 2017
    Jurisprudence Exam 
    Answer Sheet 
  • Documents required to be sent directly to the Board
    Criminal Record Check Results (FBI & Ohio BCI) - Refer to Ohio Revised Code 4715.101 Background check
    AND
    All Certification letters from any other states in which you have held or currently hold a license to practice dentistry.  Certification/Verification letters should be sent directly to the Ohio State Dental Board:
    • e-mail: licensing@den.ohio.gov
    • U.S. Mail: 77 South High Street, 17th Floor, Columbus, Ohio 43215-6135

 

    Declaring a Specialty

    (A) A licensed dentist is recognized as a specialist in Ohio if the dentist meets the standards set forth in paragraph (B) of this rule. Any licensed dentist who does not meet the standards set forth in paragraph (B) of this rule is a general dentist. A general dentist is permitted to render specialty services in Ohio.

    (B) A licensed dentist must comply with the following requirements before being recognized as a specialist in Ohio:

    (1) The indicated specialty(s) of dentistry must be those for which there are certifying boards recognized by the American dental association; and

    (2) The licensed dentist seeking specialty recognition must have successfully completed a post-doctoral education program for each specialty, which post-doctoral education program, at the time of completion, was accredited or held "preliminary provisional approval" or "accreditation eligible status" by the American dental association commission on dental accreditation; or

    (3) The requirements of paragraph (B)(2) of this rule shall not apply to otherwise qualified specialists who have announced their specialty or designation prior to August 1, 1974.

    (C) The use of the terms "specialist", "specializes" or the terms "orthodontist", "oral and maxillofacial surgeon", "oral and maxillofacial radiologist", "periodontist", "pediatric dentist", "prosthodontist", "endodontist", "oral pathologist", or "public health dentist" or other similar terms which imply that the dentist is a specialist may only be used by licensed dentists meeting the requirements of paragraph (B) of this rule.

    (D) All licensed dentists who advertise services must comport with rules 4715-13-01 to 4715-13-05 of the Administrative Code.

    (E) Rules regarding the advertising of specialty services are specifically set forth in rule 4715-13-05 of the Administrative Code.

    Declaring a Specialty Form 

    General Anesthesia and Conscious Sedation Permits

     

    General Anesthesia Permit Endorsement

    Permit Requirements: Ohio Administrative Code 4715-5-05  

    Before You Start: Make sure you have the following items or the application will not allow you to advance. All applications must be complete before submission.

    eLicense Ohio Portal- Apply Online

    Fee: $127.00 application fee  and $400.00 evaluation fee

    If you are already a licensed Dentist through the OSDB, and have not registered with the new online portal. Please contact us at licensing@den.ohio.gov with your name, license number and email address.  We will send you a registration email for the portal.  Once registered, you will be able to apply for your sedation permit on the portal by clicking option on your license and select Apply for an endorsement.   

    (1) General Anesthesia Permit Application you must provide proof of one of the following:  

    (A) Has completed an approved, accredited post-doctoral training program which affords appropriate training necessary to administer deep sedation and general anesthesia; and/or

    (B) Has completed an approved Accreditation council for graduate medical education (ACGME) accredited post-doctoral training program in anesthesiology which affords appropriate training necessary to administer deep sedation and general anesthesia: and/or

    (C) Has completed a minimum of two year advanced clinical training in anesthesiology from an American dental association commission on dental accreditation accredited institution that meets the objectives set forth in the "Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students" as adopted by the October 2007 American dental association house of delegates.

    (2) Proof of current successful completion of an advanced cardiac life support course, or its age appropriate equivalent.

    (3) Provide a copy of your blank patient medical history form.

    (4) Provide a copy of your blank patient sedation record.

    (5) Describe your drug control program. 

    (6) Proof of maintaining a permanent address within the State of Ohio in which he/she conducts business pursuant to his/her Ohio Dental License.

    (7) Proof of Properly Equipped Facility Checklist

    General Anesthesia Attestation for Additional Facility

    Conscious Sedation Permit Endorsement

    Permit Requirements:  Ohio Administrative Code 4715-5-07  

    Before You Start: Make sure you have the following items or the application will not allow you to advance. All applications must be complete before submission.

    eLicense Ohio Portal- Apply Online 
    Fee: $127 application fee  and $200 evaluation fee

    If you are already a licensed Dentist through the OSDB, and have not registered with the new online portal.  Please contact us at licensing@den.ohio.gov with your name, license number and email address.  We will send you a registration email for the portal.  Once registered, you will be able to apply for your sedation permit on the portal by clicking option on your license and select Apply for an endorsement.  

    (1) Conscious Sedation Permit Application you must provide proof of one of the following: 

    (A) Completion of a comprehensive pre-doctoral or continuing education conscious sedation training in an accredited educational institution or program, which included a minimum of sixty hours of didactic instruction and twenty cases of clinical experience commensurate with each intended route(s) of administration, whether; Oral for children twelve years or younger; or Non-intravenous parenteral; or Intravenous.

    Training in intravenous conscious sedation qualifies the permit holder to administer any route of conscious sedation.  Didactic and clinical training shall conform to the principles in the "Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students" as adopted by the October 2007 American dental association house of delegates, with clinical experience commensurate with the intended route of administration; or

    (B) Completion of an accredited post-doctoral training program which included conscious sedation training equivalent to paragraph (B) (1) of this rule; or

    (C) Completion of the qualifications governing the use of general anesthesia in rule 4715-5-05 of the Administrative Code; and

    (2) Proof of current successful completion of an advanced cardiac life support course, or its age appropriate equivalent.

    (3) Provide a copy of your blank patient medical history form.

    (4) Provide a copy of your blank patient sedation record.

    (5) Describe your drug control program. 

    (6) Proof of maintaining a permanent address within the State of Ohio in which he/she conducts business pursuant to his/her Ohio Dental license. 

    (7) Proof of Properly Equipped Facility Checklist

    Conscious Sedation Attestation for Additional Facility

    Limited Continuing Education License

    Requirements

    Limited Continuing Education License

    The Ohio State Dental Board (Board) shall, without examination, issue a temporary Limited Continuing Education license to a resident of a state other than Ohio who is licensed to practice dentistry in such state and is in good standing, is a graduate of an accredited dental college, and is registered to participate in a continuing dental education practicum in Ohio.

    The application must be endorsed by the Director of the continuing education practicum.The dentist holding a temporary Limited Continuing Education license may practice dentistry only on residents of the state in which he is permanently licensed or on patients referred by a dentist licensed in Ohio, and only while participating in a required clinical exercise of the endorsing practicum on the premises of the facility where the practicum is being conducted.

    Practice under a temporary Limited Continuing Education license shall be under the direct supervision and full professional responsibility of an instructing dentist licensed in Ohio, shall be limited to the performance of those procedures necessary to complete the endorsing practicum and shall not exceed thirty days of actual patient treatment in any year. A "treatment day" is any portion of any day during which treatment is rendered to a patient in a continuing education practicum.

    Persons applying for a Limited Continuing Education license must pay the nonrefundable application fee of $127 / Renewal $94.00; provide certification of graduation from an accredited school; certification of licensure from any states in which they currently hold or have held a license; application must be endorsed by the Director of the continuing education practicum; and proof of having been immunized against or having immunity to the hepatitis B virus.

    The Limited Continuing Education license is renewable a maximum of two times.

    Application

    Before You Start: Make sure you have the following items or the application will not allow you to advance. All applications must be complete before submission.

    eLicense Ohio Portal
    Fee: $127.00 / Renewal $94.00


    Mailing Address: Address where official Board correspondence will be mailed
    Public Address: Address displayed on Public Licensee Lookup Page
    Employment History
    Education History Background Questions

    Required Uploads:
    Certification of Dental School-We will accept the following:  Official Transcripts w/ graduation date, Certificate of Dental School-signed after graduation date (link provided), or a Letter from school with Seal-signed after graduation date
    Certificate of Director of Continuing Education Practicum
    Proof of Hepatitis B Immunity  (Immunization records or antibodies titer)
    Photograph 
    Out-of-State License Certification if applicable
    Medical Report 
    Valid Credit Card (MasterCard or Visa)

    Limited Dental Teaching License

    Requirements

    Dental Limited Teaching Licenses

    The Ohio State Dental Board (Board) may without examination issue a Limited Teaching License to a dentist who is authorized to practice dentistry in another state or country, and who has a full-time appointment to the faculty of the endorsing dental college or dental hygiene school. A person holding a limited teaching license may practice only in connection with programs operated by the endorsing dental college.

    Limited Teaching Licenses are subject to yearly renewal. The nonrefundable fee for the license is $127.00 / Renewal $127.00 for dentists. 

    The application must be certified by both the dean of the dental college, and the chairman of the department, or by the director of the dental hygiene school and a Criminal Records Check (BCI&I and FBI) completed by the Bureau of Criminal Identification and Investigation, must be submitted directly the the Board. Results shall be received by the board prior to the issuance of a license to practice. For information on obtaining a background check, you may go the their website:http://www.ohioattorneygeneral.gov/Business/Services-for-Business/WebCheck/Webcheck-Community-Listing.

    Pass a written jurisprudence examination on the Dental Practice Act, Chapter 4715. of the Ohio Revised Code. 

    Application

    Before You Start: Make sure you have the following items or the application will not allow you to advance. All applications must be complete before submission.

    eLicense Ohio Portal

    Fee: $127.00 / Renewal: $127.00

    Mailing Address: Address where official Board correspondence will be mailed 
    Public Address: Address displayed on Public Licensee Lookup Page 
    Employment History 
    Education History 
    Background Questions 

    Required Uploads: Certification of Dental School-We will accept the following:  Official Transcripts w/ graduation date, Certificate of Dental School-signed after graduation date (link provided), or a Letter from school with Seal-signed after graduation date
    Certificate of Appointment as a Teacher Certificate
    Medical Report
    Out-of-State License Certification if applicable
    Photograph

    Dental Practice Act, 2017
    Jurisprudence Exam and Exam Sheet 

    Documents required to be sent directly to Board:
    BCI/FBI Background Check 

    Valid Credit Card (MasterCard or Visa)

    Limited Resident's License

     

    Requirements

    Limited Resident's License

    The Ohio State Dental Board (Board) may grant a Limited Resident's License to a graduate of a dental school, authorized to practice in another state or country or qualified to take the regular licensing examination in this state, and who furnishes the Board satisfactory proof that he has been appointed a dental resident at an accredited dental college in this state or at an accredited program of a hospital in this state, but who has not yet been licensed as a dentist by the Board. 

    Any person receiving such Limited Resident's License may practice dentistry only in connection with programs operated by the dental college or hospital at which he is appointed as a resident as designated on his Limited Resident's License, and only under the direction of a licensed dentist who is a member of the staff thereof, or a dentist holding a current limited teaching license, and only on bona fide patients of such programs. If residency program is changed, you must submit a new application for a limited resident's license. 

    Limited Resident's License applications must be reviewed and approved by the Board. The license is valid from July 1st of the year of issue, through the termination of the residency program. 

    The nonrefundable fee for the Limited Resident's License is $13.00.

    Application

    Before You Start: Make sure you have the following items or the application will not allow you to advance. All applications must be complete before submission.

    eLicense Ohio Portal
    Fee: $13.00

    Mailing Address: Address where official Board correspondence will be mailed 
    Public Address: Address displayed on Public Licensee Lookup Page 
    Employment History 
    Education History 
    Background Questions 

    Required Uploads: Certification of Dental School-We will accept the following:  Official Transcripts w/ graduation date, Certificate of Dental School-signed after graduation date (link provided), or a Letter from school with Seal-signed after graduation date
    Dental Residency Certificate of Appointment  
    Proof of hepatitis B Immunity (Immunization records or antibodies titer)
    Photograph
    Out-of-State License Certification if applicable
    Medical Report 
    Valid Credit Card (MasterCard or Visa) 

    Oral Health Access Supervision Permit

    Information

    Authority under permit 4715.365

    Definitions regarding OHASP permit 4715.36 (G)

    Application

    Permit Requirements: Ohio Revised Code 4715-10-01

    Before You Start: Make sure you have the following items or the application will not allow you to advance. All applications must be complete before submission.

    eLicense Ohio Portal - Apply Online 
    Fee: $25.00 / Renewal: $25.00

    Mailing/ Public Address: Main Practice Location
    Employment History- Additional office locations and/or prior employment 
    Education History 
    Background Questions 

    Valid Credit Card (MasterCard or Visa)

    If RenewingOral Health Access Supervision Program Renewal Log

    Reinstatement of Dental License

     

    Requirements

    4715.14
    (A) (1) Each person who is licensed to practice dentistry in Ohio shall, on or before the first day of January of each even-numbered year, register with the state dental board. The registration shall be made on a form prescribed by the board and furnished by the secretary, shall include the licensee's name, address, license number, and such other reasonable information as the board may consider necessary, and shall include payment of a biennial registration fee of two hundred forty-five dollars. Except as provided in division (E) of this section, this fee shall be paid to the treasurer of state. Subject to division (C) of this section, a registration shall be in effect for the two-year period beginning on the first day of January of the even-numbered year and ending on the last day of December of the following odd-numbered year, and shall be renewed in accordance with the standard renewal procedure of sections 4745.01 to 4745.03 of the Revised Code.

    (2) (a) Except as provided in division (A)(2)(b) of this section, in the case of a licensee seeking registration who prescribes or personally furnishes opioid analgesics or benzodiazepines, as defined in section 3719.01 of the Revised Code, the licensee shall certify to the board whether the licensee has been granted access to the drug database established and maintained by the state board of pharmacy pursuant to section 4729.75 of the Revised Code.
    (b) The requirement in division (A)(2)(a) of this section does not apply if any of the following is the case: (i) The state board of pharmacy notifies the state dental board pursuant to section 4729.861 of the Revised Code that the licensee has been restricted from obtaining further information from the drug database. 
    (ii) The state board of pharmacy no longer maintains the drug database. 
    (iii) The licensee does not practice dentistry in this state.

    (3) If a licensee certifies to the state dental board that the licensee has been granted access to the drug database and the board finds through an audit or other means that the licensee has not been granted access, the board may take action under section 4715.30 of the Revised Code.

    (B) A licensed dentist who desires to temporarily retire from practice and who has given the board notice in writing to that effect shall be granted such a retirement, provided only that at that time all previous registration fees and additional costs of reinstatement have been paid.
    (C) Not later than the thirty-first day of January of an even-numbered year, the board shall send a notice by certified mail to a dentist who fails to renew a license in accordance with division (A) of this section. The notice shall state all of the following:
    (1) That the board has not received the registration form and fee described in that division; (2) That the license shall remain valid and in good standing until the first day of April following the last day of December of the odd-numbered year in which the dentist was scheduled to renew if the dentist remains in compliance with all other applicable provisions of this chapter and any rule adopted under it; 
    (3) That the license may be renewed until the first day of April following the last day of December of the odd-numbered year in which the dentist was scheduled to renew by the payment of the biennial registration fee and an additional fee of one hundred dollars to cover the cost of late renewal;
    (4) That unless the board receives the registration form and fee before the first day of April following the last day of December of the odd-numbered year in which the dentist was scheduled to renew, the board may, on or after the relevant first day of April, initiate disciplinary action against the dentist pursuant to Chapter 119. of the Revised Code; 
    (5) That a dentist whose license has been suspended as a result of disciplinary action initiated pursuant to division (C)(4) of this section may be reinstated by the payment of the biennial registration fee and an additional fee of three hundred dollars to cover the cost of reinstatement.

    (D) Each dentist licensed to practice, whether a resident or not, shall notify the secretary in writing or electronically of any change in the dentist's office address or employment within ten days after such change has taken place. On the first day of July of every even-numbered year, the secretary shall issue a printed roster of the names and addresses so registered.

    (E) Twenty dollars of each biennial registration fee shall be paid to the dentist loan repayment fund created under section 3702.95 of the Revised Code.

    Amended by 130th General Assembly File No. TBD, SB 276, §1, eff. 3/19/2015
    Amended by 130th General Assembly File No. TBD, HB 394, §1, eff. 3/19/2015
    Amended by 130th General Assembly File No. TBD, HB 341, §1, eff. 1/1/2015
    Amended by 130th General Assembly File No. TBD, HB 483, §101.01, eff. 1/1/2015
    Effective Date: 10-29-2003; 8/31/2010; 9/13/2010

    Application

    Before You Start: Make sure you have the following items or the application will not allow you to advance. All applications must be complete before submission.

    eLicense Ohio Portal

    Retired Status = $439.00
    Expired Status = $693.00


    UPLOADS: 
    Medical Report 
    Proof of Hep B immunity (immunization records or antibodies titer)
    Proof of 40 hours of Continuing Education 

    Jurisprudence Exam - You will need to upload only the completed answer sheet with notary section

    Documents required to be sent directly to the Board

    AND
    • All Certification letters from any other states in which you have held or currently hold a license to practice dentistry.  Certification/Verification letters should be sent directly to the Ohio State Dental Board:
    • e-mail: licensing@den.ohio.gov
    • U.S. Mail: 77 South High Street, 17th Floor, Columbus, Ohio 43215-6135

     

    Continuing Education for Reinstatement

    4715-8-04 CONTINUING EDUCATION REQUIREMENTS FOR RENEWAL OR REINSTATEMENT.
    (A) Each applicant for biennial license registration or license reinstatement shall certify that the applicant has completed the requisite hours of continuing dental education (hereinafter “CE”) since the start of the registration period. This certification shall be evidence of completion of the CE requirement as set forth in sections 4715.141, 4715.25, and 4715.58 of the Revised Code, provided that:
     (1) The board may annually select applications for biennial license registration or license reinstatement for verification that all CE requirements have been met. Licensees whose applications are selected shall submit additional documentation of compliance with CE requirements as the board may require, within thirty days.
    (2) Applicants shall keep detailed records of CE hours taken. Records of all CE undertaken shall be retained by the applicant for the period of at least four years after the completion of the CE activity, and shall be kept available for agents of the board for review. At a minimum, the following information must be retained:
    (a) Description of the CE activity;
    (b) The location of the CE activity;
    (c) The dates of attendance
    (d) The hours of each CE activity; and
    (e) A certificate or letter of completion issued by the presenter of the CE activity, if available, or any other available documentation of the completion of the CE activity, acceptable to the board. Which shall include at a minimum the following:
    (i) Name(s) of the sponsor and instructor(s);
    (ii) Course title; and
    (iii) Number of credit hours of continuing education acceptable towards Ohio licensure renewal.
    (iv) It is the licensees responsibility to ensure that courses taken fulfill the requirements set forth in sections 4715.141, 4715.25 and 4715.58 of the Revised Code and sections 4715-8-01 to 4715-8-04 of the Administrative Code.

    (B) Failure to maintain adequate records of CE activity rebuts the presumption established in paragraph (A) of this rule that the CE requirements have been completed.

    (C) Nothing in this rule shall limit the board’s authority to investigate and take action pursuant Chapter 4715. of the Revised Code.

    Effective Date: 4-5-01 Prior Effective Dates: 2-5-93; 3-3-95; 4-27-98

    Temporary Volunteer's Certificate

     

    Application

    Certificate Requirements: Ohio Revised Code 4715.421

    Before You Start: Make sure you have the following items or the application will not allow you to advance. All applications must be complete before submission.

    eLicense Ohio Portal- Apply Online

    Fee: $25.00 / Renewal: $25.00

    Mailing/ Public Address: Main Practice Location
    Employment History - Additional Office Locations and/or prior employment
    Education History
    Background Questions 

    Required Uploads:
    Identification Photo: Must be in color, Forward facing, Shoulders and above

    Hepatitis B Immunity: 
    I. Vaccination record showing all three (3) hepatitis B shots dates, OR 
            II. A Positive/ Reactive/  >10 hepatitis surface antibodies titer, OR 
    III.  At the very Least we will accept  proof that the first and second shots were administered, and the third shot (full date) is scheduled on a doctor's letterhead, script pad or appointment reminder. 
            IV. Hepatitis B Waiver Form 

    Copy of Degree from Accredited Dental College or Dental Hygiene School 

    Copy of most recent license to practice Dentistry or Dental Hygiene – Issued by a jurisdiction in the United States or in one or more branches of the United States armed services. You will also need Certification/Verification letter(s). 

    If Renewing:  A temporary volunteer’s certificate shall be valid for a period of 7 days and may be renewed upon application and payment of $25.00.  

    Valid Credit Card (MasterCard or Visa)

    Volunteer Certificate

     

    Application

    Certificate Requirements: Ohio Revised Code 4715-22-01

    ** A Volunteer certificate is issued to RETIRED Dentist or Hygienist to provide free service to indigent and uninsured persons.**

    Before You Start: Make sure you have the following items or the application will not allow you to advance. All applications must be complete before submission.

    eLicense Ohio Portal- Apply Online 
    Fee: Free

    Mailing Address: Address where official Board correspondence will be mailed
    Public Address: Address displayed on Public Licensee Lookup Page
    Employment History
    Education History 
    Background Questions 

    Required Uploads:

    Identification Photo: Must be in color, Forward facing, Shoulders and above

    Hepatitis B Immunity:

    I. Vaccination record showing all three (3) hepatitis B shots dates, OR
    II. A Postive/ Reactive/  >10 hepatitis surface antibodies titer, OR
    III.  At the very Least we will accept  proof that the first and second shots were administered, and the third shot (full date) is scheduled on a doctor's letterhead, script pad or appointment reminder. 
    IV. Hepatitis B Waiver Form

    Copy of Degree from Accredited Dental College or Dental Hygiene School 

    Copy of most recent license to practice Dentistry or Dental Hygiene – Issued by a jurisdiction in the United States or in one or more branches of the United States armed services.

    Proof of maintaining full licensure for at least 10 years prior to retirement – Full licensure in good standing, used by a jurisdiction in the United States or in one or more branches of the United States armed services, by means of a Certification/Verification letter(s)

     

    If Renewing:  A volunteer’s certificate shall be valid for a period of 3 years and be renewed upon application– no fee. 

    Eligibility for Renewal – Proof of completion of 60 hours of continuing dental education, or 18 hours of continuing dental hygiene education.  The nonprofit shelter or health care facility in which the holder provides dental or dental hygiene services may pay for or reimburse the holder for any costs incurred in obtaining the required continuing education credits.  

    Valid Credit Card (MasterCard or Visa)

    Miscellaneous Forms

    Hepatitis B Waiver
    Retirement Request