Current through Register No. 40, October 3, 2024
(a) Each applicant
for a license to practice dentistry in the state of New Hampshire shall provide
the following on the "Dentist Application for Licensure":
(1) Applicant's name;
(2) Applicant's date of birth;
(3) Applicant's place of birth;
(4) Applicant's social security number,
pursuant to RSA
161-B:11, VI-a;
(5) Any other name by which the applicant has
been known;
(6) Applicant's current
residential address, telephone number, and primary email address either
business or personal;
(7)
Applicant's educational background, including:
a. The names of the colleges
attended;
b. The date of graduation
and degree, if any;
c. The names of
the dental schools attended;
d. The
dates of attendance and graduations;
e. The types of post graduate dental programs
completed; and
f. The certificates
or degrees, if any, including specialty training
certificate;
(8) Whether
the applicant has taken and passed the examinations of the:
a. Joint Commission on National Dental
Examinations; and
b. American Board
of Dental Examiners (ADEX) examination, or other similar U.S.regional or state
board clinical examination for dentists, including a clinical periodontal
scaling component or the manikin examination;
(9) A listing of the following:
a. All places where the applicant has
possessed a license to practice dentistry, including the state and license
number, issue date, whether active or inactive, and dates of practice;
and
b. Professional employment
history including the dates, locations, and status;
(10) Whether the applicant:
a. Has been convicted of a felony,
misdemeanor, or driving under the influence of alcohol or drugs which has not
been annulled;
b. Has been
convicted of the illegal practice of dentistry;
c. Has ever been denied dental
licensure;
d. Currently has or ever
has had any professional license subjected by any professional licensing body
in any jurisdiction or state to any investigation, sanction, or disciplinary
action, including but not limited to revocation, suspension, probation or
stayed probation, limitation or restriction, fine, reprimand, denied renewal,
voluntary or involuntary relinquishment, or required submission to care,
counseling, supervision, or further education;
e. Possessed a dental license that has been
revoked, suspended, placed under probation or stayed probation, restricted, not
renewed, involuntarily relinquished, or otherwise sanctioned, or is currently
under review in any jurisdiction or state;
f. Has had any physical or mental illness
that impairs the ability to practice dentistry;
g. Has been advised by a health practitioner
or mental health practitioner that a physical or mental illness impairs the
ability to practice dentistry;
h.
Has investigations or disciplinary actions pending against the applicant's
dental license;
i. Has ever been or
is currently named as a party in any malpractice or professional liability
claim or lawsuit or has any pending;
j. Has had hospital privileges revoked,
suspended, restricted, denied, not renewed, or involuntarily relinquished;
or
k. Has ever had a DEA license
revoked, suspended, denied, placed on probation, restricted or otherwise
sanctioned by a state or federal licensing regulatory board or agency, or which
is currently involved in an investigation or disciplinary
process;
(11) Whether the
applicant has an addiction to alcohol, narcotics, or other mind altering drugs
which impairs the applicant's ability to practice dentistry;
(12) A listing of the dental continuing
education courses taken during the last 2 years;
(13) At least 3 signed certifications of good
professional character, with at least 2 by licensed dentists in good standing,
if the applicant has previous dental employment;
(14) Signed certification of graduation or,
if not more than 3 months prior to the date the degree will be conferred, a
certification of completion by the dean or registrar of the dental college
granting the applicant a degree; and
(15) Whether the applicant's CPR
certification is current, and if so, provide proof.
(16) Whether the applicant has a DEA number
to prescribe schedule II-IV controlled substances and if yes:
a. Provide the DEA number; and
b. Indicate whether or not the DEA number
will be associated with the applicant's dental
license.
(b) An
unmounted passport-type photograph of the applicant shall be:
(1) Attached to the;
(2) Taken not more than 6 months before the
date on the application;
(3) No
smaller than 2 and 1/2 inches square; and
(4) Impressed or stamped by a portion of the
seal of the dental school from which the applicant
graduated.
(c) The shall
be signed by the applicant, notarized, and filed with the office of
professional licensure and certification. Deceptive or false statements,
knowingly made by the applicant shall result in denial of license. By signing
the, the applicant shall waive any confidentiality regarding disclosure to the
board from any other jurisdiction about any pending complaints or action being
taken against his or her license to practice dentistry and consents to a
criminal background check.
(d) The
shall be accompanied by the following documents:
(1) A certified check or money order made
payable to the "Treasurer, State of New Hampshire" for the application fee
specified in Den 301.08;
(2) Either of the following:
a. An original or certified copy of the
applicant's birth certificate written in English or translated to English;
or
b. A certified copy of the
applicant's valid passport written in English or translated to English;
and
(3) A completed
criminal history records check and fingerprint card, seeking both a New
Hampshire and a federal records check, in accordance with the procedure and
payment requirements specified by the NH department of safety at Saf-C 5700,
and if the federal criminal history records check shows the existence of a
criminal record in another state, the applicant shall obtain a detailed
criminal record check directly from that state and provide it to the
board.
(e) The following
documents shall be filed with the board directly by the issuing agency:
(1) An official copy of the applicant's
dental school transcript and, if applicable, a copy of a specialty training
certificate bearing the registrar's original signature and the school's seal or
a letter on school letterhead sent directly to the board's office. An
unofficial transcript and a diploma stamped with the dental school seal may be
provided until the official transcript is ready;
(2) The applicant's original grade card
denoting successful completion of the examination of the Joint Commission on
National Dental Examinations; and
(3) A certified statement from the dental
examining board of each state in which the applicant has been licensed as to
whether the applicant's license to practice in that state based on the records
of the board, as follows:
a. Has been subject
to disciplinary action;
b. Has
disciplinary action pending;
c. Has
been under stayed probation; or
d.
Is under investigation.
(f) The board shall verify directly with the
CDCA or other similar U.S.regional or state board that the applicant has taken
and passed the board clinical examination for dentists, including a clinical
periodontal scaling component, within the 3 years immediately prior to
submitting the application.
(g)
Endorsement certification shall be considered for each applicant who holds a
current, unsuspended, unrestricted license to practice dentistry who deposits
with the board the required credentials if:
(1) The applicant has taken and passed the
American Board of Dental Examiners (ADEX) examination, or other similar
U.S.regional or state board clinical examination for dentists, including a
periodontal scaling exam; and
(2)
Throughout the 3 years immediately prior to submitting the application, the
applicant:
a. Has practiced clinical
dentistry in one or more states;
b.
Has been in dental specialty training;
c. Has been in active military dental
service; or
d. Has been in any
combination thereof.
(h) The education requirements specified in
RSA
317-A:8 shall apply to all applicants for
licensure under this section.
(i)
Pursuant to RSA
317-A:8, an applicant shall be a graduate of
a dental school general dentistry program which:
(1) Is of at least 2 years
duration;
(2) Is accredited by the
Commission on Dental Accreditation (CODA); and
(3) Awards the degree of Doctor of Dental
Medicine (DMD) or Doctor of Dental Surgery (DDS).
(j) When the required materials have been
approved by the board, the applicant shall take a test on the contents of
RSA
317-A Dental Practice Act, administrative
rules Den 100 through Den 500, the American Dental Association's Principles of
Ethics and Code of Professional Conduct, and the American Dental Hygienists'
Association Code of Ethics for Dental Hygienists.
(k) After passage of the test in (j) above,
the board shall issue an active New Hampshire dental license upon payment of
the full registration fee adopted in
Den
301.08.
(l) Required materials that are subject to
change shall be updated if more than 4 months old at the time of completion of
application.
(m) After 6 months,
the board shall discard the applications of applicants who choose not to
complete the application process.
(n) If an applicant possesses a DEA number to
prescribe schedules II-IV controlled substances pursuant to
RSA
318-B:41, I(a), the
applicant for licensure shall register with the New Hampshire Controlled Drug
Prescription Health and Safety Program (PDMP), pursuant to
RSA
126-A:91. If the applicant possesses a DEA
number, the applicant shall provide it to the board. Failure to register within
90 days of the initial issuance of a license shall constitute professional
misconduct within the meaning of
RSA
317-A:17, II and shall be
grounds for disciplinary action. A licensee shall not engage in the prescribing
or dispensing of controlled substances in schedules II-IV without having
registered with the New Hampshire PDMP.
#287.2, eff 1-17-74; ss by #2981, eff 2-28-85; amd by
#4257, eff 4-15-87; ss by #5110, eff 4-4-91; rpld by #5755, eff 12-14-93
New. #5755, eff 12-14-93 (from
Den
301.04); amd by #6186, eff 2-17-96; amd by #6541, eff
7-18-97; ss by #6909, eff 12-9-98; amd by #7270, eff 5-12-00; amd by #7557, eff
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