12 AAC 28.940. Dental licensure by examination

(a) The board will issue a license by examination to practice dentistry to an applicant who meets the requirements of AS 08.36.110 and this section.

(b) An applicant for a license under this section shall submit

(1) a complete, notarized application on a form provided by the department;

(2) the applicable fees established in 12 AAC 02.190;

(3) an affidavit from the applicant stating that the applicant is not an impaired practitioner;

(4) as required under 12 AAC 28.908(b) , a statement from the applicant certifying the applicant will adhere to the ethical standards specified in 12 AAC 28.905(b) ;

(5) an authorization from the applicant for release of the applicant's records to the department;

(6) an affidavit from the applicant that lists the license number and name of the jurisdiction for all dental licenses that the applicant holds or has ever held in any jurisdiction;

(7) a copy of a current certification in cardiopulmonary resuscitation (CPR) techniques that meets the requirements of 12 AAC 28.920, or a waiver agreement that meets the requirements of AS 08.36.070 (a)(12);

(8) a copy of the applicant's certificate of examination from the Western Regional Examining Board (WREB) or Central Regional Dental Testing Service, Inc. (CRDTS) showing the applicant has passed the clinical examination required under 12 AAC 28.105(b) or (c);

(9) a copy of the applicant's certificate of examination that meets the requirements of AS 08.36.110 (1)(B).

(c) In addition to the requirements of (a) and (b) of this section, an applicant for licensure by examination must pass the Alaska jurisprudence examination required under 12 AAC 28.105.

(d) In addition to the requirements of (a) - (c) of this section, an applicant who has not previously held a dental license in any jurisdiction before the 90 days immediately preceding the date of application or in any foreign country, shall arrange for and ensure the submission of the results of a level III Professional Background Information Services (PBIS) credentials review conducted by PBIS, sent directly to the department from PBIS.

(e) In addition to the requirements of (a) - (c) of this section, an applicant who has ever been licensed in a jurisdiction before the 90 days immediately preceding the date of application or has ever been licensed to practice dentistry in a foreign country shall submit

(1) the results of a level II Professional Background Information Services (PBIS) credentials review conducted by PBIS, sent directly to the department from PBIS;

(2) verification of the status of the applicant's registration with the Drug Enforcement Administration (DEA), sent directly to the department from DEA, even if the applicant is not currently registered with the DEA; and

(3) verification of the applicant's status and complete information regarding any disciplinary action or investigation taken or pending from all licensing jurisdictions where the applicant holds or has ever held a dental license.

History: Eff. 1/28/2000, Register 153; am 8/15/2001, Register 159; am 1/15/2003, Register 165; am 1/22/2004, Register 169

Authority: AS 08.36.070

AS 08.36.110

AS 08.36.180

Editor's note: An application for a Professional Background Information Services (PBIS) credentials review required under 12 AAC 28.940(c) may be obtained from PBIS, 9201 North 25 th Avenue, Suite 185, Phoenix, Arizona, 85021; telephone: (602) 861-5867.

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