Application Checklist

For Applicants who currently hold an Active license in another State. Your license must be an equivalent dental license, and not show discipline against the license. If your license has been disciplined, your application will need to be reviewed by the Board prior to issuance. Use this section to ensure you've submitted all requirements.

1. Completed Application: Submit online.
2. Application fee: $250.00 - Pay by credit or debit card.  All application fees are nonrefundable
3. Criminal Background Check
4. Positive Response Documentation (if applicable): If you answer "Yes" to any questions on the application, explain fully in a statement that includes all details. Include the violation, location, date, cause number, and disposition. Submit copies of court documents for each instance to support the statement. If malpractice, provide the name(s) of the plaintiff(s).
5. Name Change Documentation (if applicable):  Documentation may include a copy of your marriage certificate or divorce decree.
6. Verification of State Licensure: You must provide verification the license(s) or certification in another State. Verifications must be completed from the state of issuance and can be uploaded to your online account. Those jurisdictions may provide their own verification. Copies of license cards from other jurisdictions are not accepted as proof of verification of licensure. You must provide verification of all licenses that you have held. Your state may complete our verification form here. The top portion of this form should be completed by the applicant and sent to the appropriate state licensing board for their submission to the Indiana Professional Licensing Agency. The form may be duplicated if you hold multiple licenses. Other jurisdictions may charge a fee to verify licensure. You may wish to contact the state boards prior to your request for verification. You do not need to complete this form if you only hold licensure or certification in the State of Indiana.
7. Jurisprudence Examination: Once all above items have been reviewed and approved, the applicant will be sent a jurisprudence exam by email. All applicants for dental licensure are required to pass a jurisprudence examination. No applicant is exempt from this requirement. You will have fourteen (14) days from the date the email is sent to you in order to complete the examination and return the required information to our office. All applicants will be examined on the Statute and Rules of Indiana related to the practice of dentistry and dental hygiene, universal precautions, and infectious wastes. This is a 30 question true-false and multiple-choice examination. Passing criteria is 75%. Statutes and Administrative Rules are available on the Resources page. The jurisprudence examination is based on the following:
• Ind. Code 25-13 Dental Hygiene Law
• Ind. Code 25-14 Dental Law
• Ind. Code 25-1 Professional Licensing Agency General Provisions
• Title 828 IAC Dental and Dental Hygiene Rules
• Title 410 IAC 1-3 and 1-4 Infectious Waste and Universal Precaution

Application Checklist

For Applicants who have graduated from a Unaccredited College. Use this section to ensure you've submitted all requirements.

1. Completed Application: Submit online.
2. Application fee: $250.00 - Pay by credit or debit card.  All application fees are nonrefundable
3. Criminal Background Check
4. Positive Response Documentation (if applicable): If you answer "Yes" to any questions on the application, explain fully in a statement that includes all details. Include the violation, location, date, cause number, and disposition. Submit copies of court documents for each instance to support the statement. If malpractice, provide the name(s) of the plaintiff(s).
5. Name Change Documentation (if applicable):  Documentation may include a copy of your marriage certificate or divorce decree.
6. Transcripts:  The applicant must submit a transcript of the applicant’s dental education, including the degree conferred and the date the degree was conferred. If the transcript is in a language other than English, the applicant must include a certified translation of the transcript. If an original transcript is not available, the applicant must submit an affidavit fully and clearly stating the reasons that an original transcript is not available.
7. Clinical Training Program: Applicants must have successfully completed a clinical training program of at least two (2) years and submit an official transcript. The applicant must show completion of one of the following:
   (a) An accredited institution that reasonably ensures a level of competency equal to that of graduates of accredited dental colleges, as determined by the board.
   (b) A general practice residency program at an accredited institution.
   (c) Advanced education in a general dentistry program from an accredited institution.
8. Basic Life Support (BLS) or Advanced Cardiac Life Support (ACLS) Card: Applicants are required to submit a copy of your current BLS and/or ACLS certification card.
9. Examination Requirements
   • National Board Examination: An official score report from the National Board Dental Examinations, sent directly to the Board from the National Boards, showing passing scores in all sections of the examination. Information on how to obtain your score report and fee information can be obtained by going to their website. Only official score reports can be accepted, copies of a student score report or certificate of passing will not be accepted.
   • Clinical Examination: An applicant must pass all parts of one (1) of the following examinations. Only official score reports can be accepted, copies of a student score report or certificate of passing will not be accepted. Please have your score report sent directly to the Board from one of the entities listed below:
     • Commission on Dental Competency Assessment (CDCA), North East Regional Board (NERB), Western Regional Examining Board (WREB), and Council of Interstate Testing Agency (CITA) Website: cdcaexams.org
     • Central Regional Dental Testing Service Examination (CRDTS)
       Website: www.crdts.org
     • Southern Regional Testing Agency (SRTA)Website: www.srta.org
10. Verification of State Licensure (if applicable): If you hold a license or certification in another State, you must provide verification of that information. Verifications must be completed from the state of issuance and can be uploaded to your online account.  Those jurisdictions may provide their own verification, or complete our verification form here. Copies of license cards from other jurisdictions are not accepted as proof of verification of licensure. The top portion of this form should be completed by the applicant and sent to the appropriate state licensing board for their submission to the Indiana Professional Licensing Agency. The form may be duplicated if you hold multiple licenses. Other jurisdictions may charge a fee to verify licensure. You may wish to contact the state boards prior to your request for verification. You do not need to complete this form if you only hold licensure or certification in the State of Indiana.
11. National Practitioner Data Bank (if applicable): Applicants who are now or have been licensed to practice dentistry in another state or jurisdiction must submit a report from the National Practitioner Data Bank (NPDB). Please contact the NPDB to request a self-query report. All self-query report applications must be requested electronically through the NPDB website listed below. Information on how to complete a self-query is located on the website. Please review this helpful information on how to obtain your report. Once you receive your NPDB report, please forward the report to the Professional Licensing Agency.

National Practitioner Data Bank
P.O. Box 10832
Chantilly, Virginia 20153-0832
Website: www.npdb.hrsa.gov
Customer Service Center: 1-800-767-6732
Email: help@npdb.hrsa.gov

12. English Proficiency Exam: The applicant must pass the Test of English as a Foreign Language (TOEFL) and submit proof of such to the Board.
    Note: According to IC 25-14-1-4.5(b), the Board, at its discretion, may waive the requirements of the English proficiency examination. If you are requesting a waiver, please provide a statement listing the details of your request.
13. Jurisprudence Examination: Once all above items have been reviewed and approved, the applicant will be sent a jurisprudence exam by email. All applicants for dental licensure are required to pass a jurisprudence examination. No applicant is exempt from this requirement. You will have fourteen (14) days from the date the email is sent to you in order to complete the examination and return the required information to our office. All applicants will be examined on the Statute and Rules of Indiana related to the practice of dentistry and dental hygiene, universal precautions, and infectious wastes. This is a 30 question true-false and multiple-choice examination. Passing criteria is 75%. Statutes and Administrative Rules are available on the Resources page. The jurisprudence examination is based on the following:
• Ind. Code 25-13 Dental Hygiene Law
• Ind. Code 25-14 Dental Law
• Ind. Code 25-1 Professional Licensing Agency General Provisions
• Title 828 IAC Dental and Dental Hygiene Rules
• Title 410 IAC 1-3 and 1-4 Infectious Waste and Universal Precaution

Application Checklist

For Applicants who have graduated with an Associate Degree in Dental Hygiene from an accredited University. The applicant must have taken and passed the clinical exam less than five (5) years ago. Use this section to ensure you've submitted all requirements.

1. Completed Application: Submit online.
2. Application fee: $100.00 - Pay by credit or debit card. All application fees are nonrefundable.
3. Criminal Background Check
4. Positive Response Documentation (if applicable): If you answer "Yes" to any questions on the application, explain fully in a statement that includes all details. Include the violation, location, date, cause number, and disposition. Submit copies of court documents for each instance to support the statement. If malpractice, provide the name(s) of the plaintiff(s).
5. Name Change Documentation (if applicable): Documentation may include a copy of your marriage certificate or divorce decree.
6. Official Transcripts: Applicants must upload an official transcript obtained from the University. The transcripts from which you obtained your degree must show that all requirements for graduation have been met and the date the degree was conferred.
7. Certificate of Completion: Applicants must submit a completed Certificate of Completion completed and signed by the dean of applicant’s professional school and registrar of the university or college.
8. Basic Life Support (BLS) or Advanced Cardiac Life Support (ACLS) Card: Applicants are required to submit a copy of your current BLS and/or ACLS certification card.
9. Examination Requirements:
   • National Board Examination: An official score report from the National Board Dental Examinations, sent directly to the Board from the National Boards, showing passing scores in all sections of the examination. Information on how to obtain your score report and fee information can be obtained by going to their website. Only official score reports can be accepted, copies of a student score report or certificate of passing will not be accepted.
   • Clinical Examination: An applicant must pass all parts of one (1) of the following examinations. Only official score reports can be accepted, copies of a student score report or certificate of passing will not be accepted. Please have your score report sent directly to the Board from one of the entities listed below:
     • Commission on Dental Competency Assessment (CDCA), North East Regional Board (NERB), Western Regional Examining Board (WREB), and Council of Interstate Testing Agency (CITA) Website: cdcaexams.org
     • Central Regional Dental Testing Service Examination (CRDTS)
       Website: www.crdts.org
     • Southern Regional Testing Agency (SRTA)Website: www.srta.org
10. Verification of State Licensure (if applicable): If you hold a license or certification in another State, you must provide verification of that information. Verifications must be completed from the state of issuance and can be uploaded to your online account.  Those jurisdictions may provide their own verification, or complete our verification form here. Copies of license cards from other jurisdictions are not accepted as proof of verification of licensure. The top portion of this form should be completed by the applicant and sent to the appropriate state licensing board for their submission to the Indiana Professional Licensing Agency. The form may be duplicated if you hold multiple licenses. Other jurisdictions may charge a fee to verify licensure. You may wish to contact the state boards prior to your request for verification. You do not need to complete this form if you only hold licensure or certification in the State of Indiana.
11. National Practitioner Data Bank (if applicable): Applicants who are now or have been licensed in another state or jurisdiction must submit a report from the National Practitioner Data Bank (NPDB). Please contact the NPDB to request a self-query report. All self-query report applications must be requested electronically through the NPDB website listed below. Information on how to complete a self-query is located on the website. Please review this helpful information on how to obtain your report. Once you receive your NPDB report, please forward the report to the Professional Licensing Agency.

National Practitioner Data Bank
P.O. Box 10832
Chantilly, Virginia 20153-0832
Website: www.npdb.hrsa.gov
Customer Service Center: 1-800-767-6732
Email: help@npdb.hrsa.gov

12. Jurisprudence Examination: Once all above items have been reviewed and approved, the applicant will be sent a jurisprudence exam by email. All applicants for dental licensure are required to pass a jurisprudence examination. No applicant is exempt from this requirement. You will have fourteen (14) days from the date the email is sent to you in order to complete the examination and return the required information to our office. All applicants will be examined on the Statute and Rules of Indiana related to the practice of dentistry and dental hygiene, universal precautions, and infectious wastes. This is a 30 question true-false and multiple-choice examination. Passing criteria is 75%. Statutes and Administrative Rules are available on the Resources page. The jurisprudence examination is based on the following:
• Ind. Code 25-13 Dental Hygiene Law
• Ind. Code 25-14 Dental Law
• Ind. Code 25-1 Professional Licensing Agency General Provisions
• Title 828 IAC Dental and Dental Hygiene Rules
• Title 410 IAC 1-3 and 1-4 Infectious Waste and Universal Precaution

Application Checklist

For Applicants who currently hold an Active license in another State. Your license must be an equivalent dental hygiene license, and not show discipline against the license. If your license has been disciplined, your application will need to be reviewed by the Board prior to issuance. Use this section to ensure you've submitted all requirements.

1. Completed Application: Submit online.
2. Application fee: $100.00 - Pay by credit or debit card. All application fees are nonrefundable.
3. Criminal Background Check
4. Positive Response Documentation (if applicable): If you answer "Yes" to any questions on the application, explain fully in a statement that includes all details. Include the violation, location, date, cause number, and disposition. Submit copies of court documents for each instance to support the statement. If malpractice, provide the name(s) of the plaintiff(s).
5. Name Change Documentation (if applicable):  Documentation may include a copy of your marriage certificate or divorce decree.
6. Verification of State Licensure: You must provide verification the license(s) or certification in another State. Verifications must be completed from the state of issuance and can be uploaded to your online account. Those jurisdictions may provide their own verification. Copies of license cards from other jurisdictions are not accepted as proof of verification of licensure. You must provide verification of all licenses that you have held. Your state may complete our verification form here. The top portion of this form should be completed by the applicant and sent to the appropriate state licensing board for their submission to the Indiana Professional Licensing Agency. The form may be duplicated if you hold multiple licenses. Other jurisdictions may charge a fee to verify licensure. You may wish to contact the state boards prior to your request for verification. You do not need to complete this form if you only hold licensure or certification in the State of Indiana.
7. Jurisprudence Examination: Once all above items have been reviewed and approved, the applicant will be sent a jurisprudence exam by email. All applicants for dental licensure are required to pass a jurisprudence examination. No applicant is exempt from this requirement. You will have fourteen (14) days from the date the email is sent to you in order to complete the examination and return the required information to our office. All applicants will be examined on the Statute and Rules of Indiana related to the practice of dentistry and dental hygiene, universal precautions, and infectious wastes. This is a 30 question true-false and multiple-choice examination. Passing criteria is 75%. Statutes and Administrative Rules are available on the Resources page. The jurisprudence examination is based on the following:
• Ind. Code 25-13 Dental Hygiene Law
• Ind. Code 25-14 Dental Law
• Ind. Code 25-1 Professional Licensing Agency General Provisions
• Title 828 IAC Dental and Dental Hygiene Rules
• Title 410 IAC 1-3 and 1-4 Infectious Waste and Universal Precaution

Application Checklist

For Applicants who are employed by the Indiana University School of Dentistry (This license is only for Dentists). Use this section to ensure you've submitted all requirements.

1. Completed Application: Submit online.
2. Application fee: $250.00 - Pay by credit or debit card. All application fees are nonrefundable.
3. Letter from University: A letter from the Indiana University School of Dentistry verifying your employment and Education with their program.
4. Positive Response Documentation (if applicable): If you answer "Yes" to any questions on the application, explain fully in a statement that includes all details. Include the violation, location, date, cause number, and disposition. Submit copies of court documents for each instance to support the statement. If malpractice, provide the name(s) of the plaintiff(s).
5. Name Change Documentation (if applicable):  Documentation may include a copy of your marriage certificate or divorce decree.
6. Official Transcripts: Applicants must upload an official transcript obtained from the University. The transcripts from which you obtained your degree must show that all requirements for graduation have been met and the date the degree was conferred.
7. Examination Requirements
   • National Board Examination: An official score report from the National Board Dental Examinations, sent directly to the Board from the National Boards, showing passing scores in all sections of the examination. Information on how to obtain your score report and fee information can be obtained by going to their website. Only official score reports can be accepted, copies of a student score report or certificate of passing will not be accepted.
   • Clinical Examination: An applicant must pass all parts of one (1) of the following examinations. Only official score reports can be accepted, copies of a student score report or certificate of passing will not be accepted. Please have your score report sent directly to the Board from one of the entities listed below:
     • Commission on Dental Competency Assessment (CDCA), North East Regional Board (NERB), Western Regional Examining Board (WREB), and Council of Interstate Testing Agency (CITA) Website: cdcaexams.org
     • Central Regional Dental Testing Service Examination (CRDTS)
       Website: www.crdts.org
     • Southern Regional Testing Agency (SRTA)Website: www.srta.org
8. Verification of State Licensure: If you hold a license or certification in another State, you must provide verification of that information. Verifications must be completed from the state of issuance and can be uploaded to your online account.  Those jurisdictions may provide their own verification, or complete our verification form here. Copies of license cards from other jurisdictions are not accepted as proof of verification of licensure. The top portion of this form should be completed by the applicant and sent to the appropriate state licensing board for their submission to the Indiana Professional Licensing Agency. The form may be duplicated if you hold multiple licenses. Other jurisdictions may charge a fee to verify licensure. You may wish to contact the state boards prior to your request for verification. You do not need to complete this form if you only hold licensure or certification in the State of Indiana.
9. National Practitioner Data Bank: Applicants who are now or have been licensed to practice dentistry in another state or jurisdiction must submit a report from the National Practitioner Data Bank (NPDB). Please contact the NPDB to request a self-query report. All self-query report applications must be requested electronically through the NPDB website listed below. Information on how to complete a self-query is located on the website. Please review this helpful information on how to obtain your report. Once you receive your NPDB report, please forward the report to the Professional Licensing Agency. 
   National Practitioner Data Bank
   P.O. Box 10832
   Chantilly, Virginia 20153-0832
   Website: www.npdb.hrsa.gov
   Customer Service Center: 1-800-767-6732
   Email: help@npdb.hrsa.gov
10. Proof of Continuing Education: Applicants are required to submit proof of twenty (20) hours of continuing dental education taken in the previous two (2) years. No more than two (2) hours of training in basic life support shall count toward this requirement. Copies of certificates, letters from programs and/or transcripts are required.
11. English Proficiency Exam: The applicant must pass the Test of English as a Foreign Language (TOEFL) and submit proof of such to the Board.
    Note: According to IC 25-14-1-4.5(b), the Board, at its discretion, may waive the requirements of the English proficiency examination. If you are requesting a waiver, please provide a statement listing the details of your request.
12. Proof of Practice: The applicant must provide a statement listing where they have been employed (include dates of employment and practice address) for 5 years out of the 9 years.
13. Basic Life Support (BLS) or Advanced Cardiac Life Support (ACLS) Card: Applicants are required to submit a copy of your current BLS and/or ACLS certification card.
14. Affidavit of Practice: Letter verifying that the Applicant will certify that they will teach and practice dentistry only at or on behalf of an Indiana school of Dentistry or an affiliated medical center of an Indiana School of Dentistry. The applicant shall further certify that the applicant will not engage in the private practice of dentistry.

Application Checklist

For Applicants who are employed by the Indiana University School of Dentistry (This license is only for Dentists). Use this section to ensure you've submitted all requirements.

1. Completed Application: Submit online.
2. Letter from University: Please provide a letter from the school of Dentistry verifying their employment with the University including time of employment.
3. Positive Response Documentation (if applicable): If you answer "Yes" to any questions on the application, explain fully in a statement that includes all details. Include the violation, location, date, cause number, and disposition. Submit copies of court documents for each instance to support the statement. If malpractice, provide the name(s) of the plaintiff(s).

Application Checklist

For Applicants who are enrolled in residency program by the Indiana University School of Dentistry (This license is only for Dentists). Use this section to ensure you've submitted all requirements.

1. Completed Application: Submit online.
2. Letter from University: Please provide a letter from the school of Dentistry verifying your enrollment in the residency program. This letter should include the dates of the residency and name of your supervisor with their Indiana license credential information.

Application Checklist

For Applicants who licensed Dentists in the State of Indiana and wish to employ General Anesthesia, Deep Sedation, or Light Parenteral Conscious Sedation.

1. Completed Application: Submit online.
2. Application fee: $50.00 - Pay by credit or debit card. All application fees are nonrefundable. Additional office address(s) must be submitted by paper notification to our office. Please see information below.
3. Proof of Sedation Training: An applicant must indicate which level of Sedation permit they wish to obtain on their application, and provide proof of training for one of the following :
   • General Anesthesia: An applicant for a permit to employ general anesthesia  must provide satisfactory evidence of completing a minimum of one (1) year of advanced (postdoctoral) training in anesthesiology and related academic subjects (postdoctoral) beyond the undergraduate dental school level in a residency in anesthesiology or oral surgery which meets the requirements stated in 828 IAC 3-1-3. Applicants must submit one of the following documents:
     • A copy of a certificate of completion of the educational or training program signed by the dean of the board approved dental school or director of the board approved anesthesiology residency from which the training was obtained.
     • An official transcript, sent directly from the school, from the board approved dental school which clearly designates completion of the education or training.
   • Deep Sedation: An applicant for a permit to employ general anesthesia  must provide satisfactory evidence of completing a minimum of one (1) year of advanced (postdoctoral) training in anesthesiology and related academic subjects (postdoctoral) beyond the undergraduate dental school level in a residency in anesthesiology or oral surgery which meets the requirements stated in 828 IAC 3-1-3. Applicants must submit one of the following documents:
     • A copy of a certificate of completion of the educational or training program signed by the dean of the board approved dental school or director of the board approved anesthesiology residency from which the training was obtained.
     • An official transcript, sent directly from the school, from the board approved dental school which clearly designates completion of the education or training.
   • Light Parenteral Conscious Sedation: An applicant who wishes to employ Light Parenteral Conscious Sedation must meet one (1) of the following educational and training criteria:
     • The applicant graduated from an approved dental school which included training in conscious sedation techniques at the predoctoral level. This training must meet the requirements of 828 IAC 3-1-5.
     • The applicant completed an intensive postdoctoral training program in the use of light parenteral conscious sedation which meets the requirements of 828 IAC 3-1-5.
     • Applicants must submit one of the following documents:
       • A copy of a certificate of completion of the educational or training program signed by the dean of the board approved dental school, medical school or director of a board approved hospital program from which the training was obtained.
       • An official transcript from a board approved dental school which clearly designates completion of the education or training.
       • A copy of a certificate of completion of a continuing education program which meets the requirements of 828 IAC 3-1-5. The certificate of completion shall be signed by the director of the continuing education program.
4. Advanced Cardiac Life Support (ACLS) Card: Applicants are required to submit a copy of your current ACLS certification card.

To Add Additional Offices and/or Hospitals

To add an additional office and/or hospital where you intend to administer general anesthesia, deep sedation, or light parenteral conscious sedation you will be required to submit the following:

1. Statement: A written request for an additional office and/or hospital with the dentist name, additional location, license and permit number.
2. Application Fee: $25.00 - Make the check or money order payable to Indiana Professional Licensing Agency.  All application fees are nonrefundable.

Application Checklist

For Applicants who licensed Dental Hygienist in the State of Indiana and wish to employ local anesthetic.

Completed Application	Application Fee ($25)	Proof of Anesthetic Training
Local Anesthetic Examination

1. Completed Application: Submit online.
2. Application Fee: $25.00 - Pay by credit or debit card. All application fees are nonrefundable.  Additional office address(s) must be submitted by paper notification to our office. Please see information below.
3. Proof of Anesthetic Training from School:
   • Applicants must submit an official document, directly from the school or program, showing proof of completion of Anesthetic training (must include University name and date earned). This must be a course in local anesthesia administration from an educational program accredited by the Commission on Dental Accreditation of the American Dental Association (CODA) that includes, at a minimum, fifteen (15) hours of didactic instruction and fourteen (14) hours of laboratory work covering the following subject areas:
     (1) Theory of pain control.
     (2) Selection of pain control modalities.
     (3) Anatomy.
     (4) Neurophysiology.
     (5) Pharmacology of local anesthesia.
     (6) Pharmacology of vasoconstrictors.
     (7) Psychological aspects of pain control.
     (8) Systemic complications.
     (9) Techniques of maxillary and mandibular anesthesia.
     (10) Infection control.
     (11) Local anesthesia medical emergencies.
     (12) A demonstration of clinical competency.
4. Clinical Examination Requirement: Applicants must submit verification of an official report showing the score attained on the local anesthesia examination. This exam must be local anesthesia focused (the clinical exam you completed for your dental hygiene program might not always apply). Please have your score report sent directly to the Board from one of the entities listed below:
   • Commission on Dental Competency Assessment (CDCA), North East Regional Board (NERB), Western Regional Examining Board (WREB), and Council of Interstate Testing Agency (CITA) Website: cdcaexams.org
5. REGIONAL OR STATE EXAMINATION: If you are licensed in another State and completed their own constructed exam for local anesthetic, please have that State provide a copy of the exam for the Board to review.

****If you have not completed a local anesthesia examination administered by one of the entities listed above but have taken a substantially equivalent regional or state examination, please have the state or regional entity submit verification of the examination administered directly to the Board for review.

Application Checklist

Use this section to ensure you've submitted all requirements.

1. Completed Application: Submit online.
2. Application fee: $60.00 - Pay by credit or debit card. All application fees are nonrefundable.
3. Continuing Education: Effective July 1, 2019, any licensed provider who applies for a controlled substance registration or renews a controlled substance registration must have two hours of continuing education in opioid abuse and prescribing to obtain or renew the registration. The two hours must be obtained within the previous two years prior to applying for or renewing a registration. Individuals applying for a controlled substance registration who have not yet received their professional license do not need to complete the two hours of CE. Providers applying for a controlled substance registration who already hold a professional license will need to submit proof of the two hours of continuing education with their application.
4. Go to https://www.in.gov/pla/professions/controlled-substance-registration/ for application and instructions.

Application Checklist

For Applicants who have Dental Mobile Dental Facility or portable Dental Operation. Use this section to ensure you've submitted all requirements.

1. Completed Application: Submit online.
2. Application fee: $200.00 - Pay by credit or debit card. All application fees are nonrefundable.
3. Required Documentation: Please be prepared to upload the following documents:

• Proof of Communication Facility: Applicants must provide proof that they have a stationary location for record retention and communication of their mobile units.
• Proof of Radiographic Equipment Inspection: Applicants must show proof that they have radiographic equipment for their mobile units, and proof that they have met all safety regulations per the requirements set forth by the Department of Health.
• Emergency Care Procedure: Applicant must show an example of their emergency procedures of what actions they are taking to ensure patient care inside their mobile units.
• Letters of Support: Must provide copies of letters of support for the mobile Dental Facility.
• Valid Driver's License: Must show proof that the driver of the mobile unit holds a valid Driver's license in the State of Indiana.
• Copy of Consent Form: Must provide an example of the patient consent form they will complete when they use the mobile facility.
• Patient Information Sheet: Must show an example of the patient information sheet that the clients will complete when they use the mobile facility.

The Indiana Professional Licensing Agency does not issue licenses, permits, or certification for the practice of Dental Assisting. Please contact the Indiana Board of Health if you are a Dental Assistant who needs certification for your x-ray qualifications.

Reinstatement Information
If your license has been expired for three or more years, you must reinstate your license to practice. One renewal cycle is 20 hours of CE with 2 hours of Indiana ethics for Dentists, and 19 hours with 2 hours of Indiana ethics for Dental Hygienists. Please submit your reinstatement online with the additional documentation:

• Reinstate your license online at https://mylicense.in.gov/eGov/index.html (Please note this is not the same link for renewals)
• Payment of the current renewal fee and current application fee.
• Documentation to Upload:
  • Copy of current CPR card. It will count for no more than (2) hours of your continuing education requirements.
  • Proof of continuing education since your license expired which must including 2 hours of Indiana ethics and jurisprudence (example: if you expired in 2016 you would show proof of CE from March 2014 to the present. This is to include the CE you should have been accruing during the time from your last active cycle to the present). Copies of certificates, letters from programs and/or transcripts are required. Please upload your CE into one pdf attachment.
  • Statement of Practice. Please provide a brief statement in your own words on what you have been doing since your Indiana license has expired.

Upon receipt of the above items you may be scheduled to appear before the Board. The Board will determine if you will need to complete such remediation and/or additional training as deemed appropriate.

Reinstatement of an Inactive License Information
Inactive status as an Indiana Dentist or Dental Hygienist. One renewal cycle is 20 hours of CE with 2 hours of Indiana ethics for Dentists, and 19 hours with 2 hours of Indiana ethics for Dental Hygienists. Please review the fee schedule for the amounts needed to reinstate. All items must be submitted in one packet for review, if your packet is incomplete, it will be returned.

• Reinstate your license online at https://mylicense.in.gov/eGov/index.html (please note this is a different platform than the mentioned renewal link mentioned above.)
• Submit the Application Fee and the Late Fee ($50)
• Copy of current CPR card. It will count for no more than (2) hours of your continuing education requirements.
• Show proof of half the required continuing education needed since your license was inactivated. You must show completion of two (2) hours of Indiana ethics and jurisprudence.  (example: if you expired in 2016 you would show proof of CE from March 2014 to the present. This is to include the CE you should have been accruing during the time from your last active cycle to the present). Copies of certificates, letters from programs and/or transcripts are required. Please upload your CE into one pdf attachment.
• Statement of Practice. Please provide a statement in your own words on what you have been doing since your Indiana license has been inactive.

Upon receipt of the above items you may be scheduled to appear before the Board. The Board will determine if you will need to complete such remdiation and/or additional training as deemed appropriate.

Mobile Dental Facility Reinstatement
Reinstate your license online at https://mylicense.in.gov/eGov/index.html (please note this is a different platform than the mentioned renewal link mentioned above.) In order to do this, you must have your license number and Registration Code.  If you need your registration code, contact PLA at 317-232-2960 for the Call Center or email pla8@pla.in.gov.

APPROVED ORGANIZATIONS 
Approved organizations are also defined in three separate sections of the statute for Dentists and Dental Hygienists. One in the dental hygienists statutes (25-13-2-2); the dental statutes (25-14-3-2) and one in the Professional Licensing Agency statutes (25-1-4-0.2).

IC 25-13-2-2
"Approved organization" means the following:

1. United States Department of Education.
2. Council on Post-Secondary Education.
3. National Dental Association.
4. American Dental Association.
5. Academy of General Dentistry.
6. National Dental Hygiene Association.
7. American Dental Hygiene Association.
8. Council on Hospital Dental Services.
9. American Medical Association.
10. Joint Commission on Accreditation of Hospitals.
11. Joint Commission on Healthcare Organizations.
12. Study clubs approved by the board.
13. Federal, state, and local government agencies.
14. International organizations approved by the American Dental Association.
15. A college or other teaching institution accredited by the United States Department of Education or the Council on Post-Secondary Education.
16. A national, state, district, or local organization that operates as an affiliated entity under the approval of an organization listed in subdivisions (1) through (14).
17. An internship or a residency program conducted in a hospital that has been approved by an organization listed in subdivisions (1) through (15).
18. Any other organization or individual approved by the board.

IC 25-14-3-2
Approved organization means the following:

1. United States Department of Education.
2. Council on Post-Secondary Education.
3. National Dental Association.
4. American Dental Association.
5. Academy of General Dentistry.
6. National Dental Hygiene Association.
7. American Dental Hygiene Association.
8. Council on Hospital Dental Services.
9. American Medical Association.
10. Joint Commission on Accreditation of Hospitals.
11. Joint Commission on Healthcare Organizations.
12. Study clubs approved by the board.
13. Federal, state, and local government agencies.
14. International organizations approved by the American Dental Association.
15. A college or other teaching institution accredited by the United States Department of Education or the Council on Post-Secondary Education.
16. A national, state, district, or local organization that operates as an affiliated entity under the approval of any organization listed in subdivisions (1) through (14).
17. An internship or a residency program conducted in a hospital that has been approved by an organization listed in subdivisions (1) through (15).
18. Any other organization or individual approved by the board.

IC 25-1-4-0.2
"Approved organization" refers to the following:

1. United States Department of Education.
2. Council on Post-Secondary Education.
3. Joint Commission on Accreditation of Hospitals.
4. Joint Commission on Healthcare Organizations.
5. Federal, state, and local government agencies.
6. A college or other teaching institution accredited by the United States Department of Education or the Council on Post-Secondary Education.
7. A national organization of practitioners whose members practicing in Indiana are subject to regulation by a board or agency regulating a profession or occupation under this title or IC15.
8. A national, state, district, or local organization that operates as an affiliated entity under the approval of an organization listed in subdivisions (1) through (7).
9. An internship or a residency program conducted in a hospital that has been approved by an organization listed in subdivisions (1) through (7).
10. Any other organization or individual approved by the board.

It is the responsibility of the organization, If not specifically listed in the statute as an approved organization, or study club to request approval from the Board. An organization or study club will be able to tell licensees whether it has been approved by the Board. An approved organization or study club must provide participants with verification of course completion. Applications for approval of continuing education organization or study clubs are available at the Board’s website at http://www.in.gov/pla .

Courses given or sponsored by an approved organization regarding infectious diseases, universal precautions, and infection control will be accepted.

• Commission on Dental Competency Assessment (CDCA), North East Regional Board (NERB), Western Regional Examining Board (WREB), and Council of Interstate Testing Agency (CITA) Website: cdcaexams.org

• Central Regional Dental Testing Service Examination (CRDTS)
  Website: www.crdts.org