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Applications and Forms

Dentist, Dental Hygienist or Denturist License Application

The Arizona State Board of Dental Examiners' Initial License Application is available below. Once complete with the license application, including your e-signature, your application, along with any supporting documents you may have attached will be emailed directly to Board staff. Where applicable, most of the documentation can be attached to the online application. Other documents like, other jurisdictional license verifications, transcripts, exam scores, etc. are required to be submitted by that generating source. If you forget to attach supporting documents, or there is a delay in doing so, you may email them directly to the Board's email at [email protected]. You may also deliver your documents by mail/courier to:

Arizona State Board of Dental Examiners

1740 West Adams Street, Suite 2470

Phoenix, Arizona 85007

Below are other documents that are useful in your application submission and may also be required as part of your initial application submission. The Initial Application Instructions are available, separately, for you to get organized prior to completing your initial application. The Statement of Citizenship form is required for all applicants regardless of how you intend to apply and requires that the applicant satisfactorily demonstrate that he/she is lawfully present to work in the United States. The Verification of a Non-Arizona Dental License form is available for individuals to send to other U.S. jurisdictions in which the applicant currently holds, has held or applied for a dental license. 

INITIAL APPLICATION INSTRUCTIONS - downloadable document

INITIAL APPLICATION - online submission

STATEMENT OF CITIZENSHIP FORM - download and save in order to attach to an Initial or Renewal Application

Pursuant to A.R.S. § 32-4302, a person shall be granted an occupation or professional license or certificate if the person has been licensed or certified in another state for at least twelve months, the license or certificate is in the same discipline and at the same practice level as the license or certificate for which the person is applying in this state and the person meets other conditions prescribed by section 32-4302.

 

Jurisprudence Examination

As part of your initial application, all applicants will be required to submit a copy of his/her certificate of completion of the Board’s jurisprudence examination. The jurisprudence examination covers the Arizona Revised Statutes (Laws) and Arizona Administrative Code (Rules) governing dentistry in the State of Arizona. There are two separate fees - the first is $35.00 and is payable at the time of testing. The second fee is what's called an examination fee, which is dependent on the profession applying for and is paid as part of your application fee(s). The examination consists of 50 multiple choice questions and because it is given online it is considered to be an "open book" test. You will be given an hour to complete the examination and must obtain a score of 75% or higher to pass the examination.

To take this required, nonrefundable exam covering the Board’s laws (statutes) and rules, please follow these simple directions:

  1. Study the Board’s laws and rules by downloading both here: STATUTES and RULES or at https://dentalboard.az.gov/publications-articles.
  2. Once prepared, take the examination at https://txn.esslearning.com/catalogs/azbde/, but please select the appropriate examination based on your specific dental profession and pay the examination testing fee of $35.00.
  3. Lastly, please submit a copy of your certificate of completion directly to the Board’s office.

 

License Verifications

VERIFICATION OF A NON-ARIZONA DENTAL LICENSE - download, save, print, sign and date and forward to all other jurisdictions for verification of licensure when verifying any other license you hold, held or applied for.

VERIFICATION OF AN ARIZONA DENTAL LICENSE - online submission

 

Dental Hygienist Local Anesthesia and Nitrous Oxide Analgesia Certification

Dental Hygienists may also choose to be certified in local anesthesia and/or nitrous oxide analgesia. To be considered for this certification, please complete the LOCAL ANESTHESIA AND NITROUS OXIDE ANALGESIA APPLICATION.

 

Dental Assistant Radiology Certification by Credential

ONLINE APPLICATION for certification by credential

 

Name Change Form

Pursuant to A.R.S. § 32-1262(H), if you legally change your name and wish that your license be in the new name, please use the link below to complete and complete a name change form.

NAME CHANGE FORM - online Submission (Once all required fields are completed, a "Click to Sign" button will display at the bottom of your screen.)

 

Address Change Form

Pursuant to A.R.S. §§ 32-1236(I), 32-1276.02(E), 32-1287(E) and 32-1297.06(G), A licensee/certificate holder shall notify the board in writing within ten days after the licensee changes the primary mailing address listed with the board.

ADDRESS CHANGE FORM - online Submission

 

Public Records Request

Pursuant to A.A.C. R4-11-405, the Board shall charge the following [fees] for the services provided. Payment should be made by credit card using the Board's payment portal, or by money order or cashier's check. Payment must be received in full prior to the release of any public record(s).

  1. Copy of Audio Recording.........................................$10 (available for free on the Board's meetings' page);
  2. Photocopies................0.25/page (minimum fee of $2.50 for 9 pages or fewer if paying by paper); and
  3. Mailing lists (digital format)...........................................................................................................................................$100.

PUBLIC RECORDS REQUEST - online Submission

 

Malpractice Form

MALPRACTICE FORM - Required to be completed if you answered yes to question 4 in the "CONDUCT" section of the Initial Application - downloadable document

 

                                                           

Pursuant to A.R.S. § 41-1093.01, an agency shall limit all occupational regulations to regulations that are demonstrated to be necessary to specifically fulfill a public health, safety or welfare concern.

Pursuant to A.R.S. §§ 41-1093.02 and 41-1093.03, you have the right to petition this agency to repeal or modify the occupational regulation or bring an action in a court of general jurisdiction to challenge the occupational regulation and to ensure compliance with section 41-1093.01.