Contact for Re-apply for a limited dental intern license
Board of Registration in Dentistry
The Details of Re-apply for a limited dental intern license
What you need for Re-apply for a limited dental intern license
Practice location information
- Name, address, and phone of sponsoring institution/clinic
- Date of practice to begin
- Name of supervising dentist
- Massachusetts Dental License number
We must have these attachments to process your application.
Documentation of certifications
Documentation of Current CPR/AED for the Professional Rescuer or Current BLS Certification
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
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
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.
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.
You must sign the affidavit on the application and have it witnessed by a Notary Public.
Fees for Re-apply for a limited dental intern license
- We accept personal checks, business checks, or money orders. Make it payable to the Commonwealth of Massachusetts.
- All fees are nonrefundable and nontransferable
- Please don't staple payment to the application
- Please don't send cash
|Dental limited license fee||$90||each|
|Handling charge for returned checks||$23||each|
How to apply Re-apply for a limited dental intern license
- Download the application below
- Fill out the application
- Include the fee and all attachments
- Mail completed application and all attachments to:
Massachusetts Board of Registration in Dentistry
239 Causeway St.
Boston, MA 02114
Next steps for Re-apply for a limited dental intern license
Please retain a copy of all application materials for your records.