Section 4.04 - Initial Dentist Licensure by CredentialsThe 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.Amended by Mass Register Issue 1271, eff. 10/10/2014.Amended by Mass Register Issue 1363, eff. 4/20/2018.