Apply for a limited dental intern license

Application attachments

We must have these attachments to process your application.

Proof of Graduation

• One of the following:
  • Original transcript with school seal indicating your date of graduation and degree awarded, or
  • Original, signed letter from the Dean’s or Registrar’s office indicating your date of graduation and degree awarded
  • Foreign trained dentists:
    • An original transcript from your foreign dental school indicating your date of graduation and degree awarded. If the transcript is not written in English, we require an official translation into English.
  • Photocopies are not acceptable

Documentation of certifications

Either one of the following documents:

• Current certification in American Red Cross Cardiopulmonary Resuscitation/Automated External Defibrillation for the Professional Rescuer (CPR/AED), or
• Current certification in American Heart Association Basic Life Support for Healthcare Providers (BLS)

Massachusetts Dental Ethics and Jurisprudence Exam

• Answer sheet only
• Request a copy here

If applicable

Criminal Offender Record Information (CORI) Acknowledgment Form

• You will need this if you have answered “yes” to any of the questions in the Good Moral Character Questions section
• This form is attached in the application
• This must be signed in person, and witnessed by either a BHPL employee at the Board's offices or a notary public
  • The BPHL employee or notary public must verify your identity through acceptable identification

Letters of Standing

• Official verification of professional licensure from each state or jurisdiction in which you now hold, or ever have held, a license
• The official letter must include the current status of your license, license number, the official seal and signature of the jurisdiction’s licensing Board, and any disciplinary action taken
• A photocopy of a license is not acceptable
• A copy of a screen shot from the jurisdiction’s licensing Board website is also not acceptable

Practice History

• If you have ever practiced dentistry in another jurisdiction or state, please include an up-to-date resume, curriculum vitae or practice history.

National Practitioner Data Bank Self-Query

• Attach if you have ever held a professional healthcare license in the United States
• To request a self-query please contact the Data Bank at (800) 767-6732 or go to the NPDB website
• The Data Bank will mail the report to you. A copy of the original NPDB report is acceptable.

English Language Proficiency

If your dental degree is from a dental school whose curriculum, including textbooks, was conducted in a language other than English, then you must also include proof of a minimum passing score on the TOEFL or IETLS exam.

Good moral standing

If you answer "yes" to any of the moral standing questions on the application:

• Attach a separate sheet explaining the circumstances
• Also provide all relevant certified documentation (police reports, court records, disciplinary action reports, etc.). Include final disposition of the matter.

Other requirements

A photo of yourself

You will need to attach, where indicated, a color photograph, passport-sized (2” x 2”) or larger.

Affidavit

You must sign the affidavit on the application and have it witnessed by a Notary Public.

Employment

Please note you must secure employment as a dental intern or full-time faculty member before applying for a limited license.