665 Mainstream Drive
Nashville, TN 37243
Applications
Dentists, Dental Hygienists, and Registered Dental Assistants
2 days ago - Army spouse licensure reimbursement policy add. Estate boards, with details on state licensing requirements and reciprocity agreements. The state licensing and career credentials initiative is designed to help make it easier to transition your credentials to a new state. Whether you're already a licensed or certified professional, or are planning to become one, the process will now be easier for service members and their spouses when relocating.
- Declaration of Citizenship (PH-4183)
- Declaration of Eligibility for Expedited Licensure Process for a Military Member (PH-4279)
- Declaration of Eligibility for Expedited Licensure Process for a Spouse of Military Member (PH-4280)
- Name and Address Change Request (PH-3619)
- Retirement - Affidavit of Retirement From Practice in Tennessee (PH-3460)
- Course Evaluation Form for Individual Licensees/Registrants Seeking Approval of Continuing Education Courses (PH-3867)
- Application for Duplicate License (PH-3872)
- Reinstatement/Reactivation Application (PH-3870)
Dentists
► Applying for initial licensure from your professional licensing board has become a bit easier. For the past year, the Department of Health has been working on an online application process that will allow all health care professionals to apply online for an initial license and complete (and update as necessary) a practitioner profile mandatory for certain professions. The process is user friendly and convenient and even allows you to pay for your initial application utilizing a credit card, debit card or e-check. You will also be able to upload many of the documents required to complete your initial application! Please go to the initial application link below to begin the online process.
- Application for Licensure as a Dentist (PH-3168)
- Application for Licensure as a Dentist by Criteria (Reciprocity) (PH-3802)
- Application for Limited and Limited Educational Licensure (PH-3592)
- Mandatory Practitioner Profile Questionnaire for Licensed Health Care Providers (PH-3585)
- Application Instructions for Conscious Sedation Permit (PH-2865)
- Application Instructions for Deep Sedation/General Anesthesia Permit (PH-3172)
- Application for Specialty Certification (PH-3873)
- Application for Inactive Pro Bono Dental License (PH-3892)
- Application for Special Volunteer License for Dentists and Dental Hygienists (PH-3891)
Dental Hygienists
► Applying for initial licensure from your professional licensing board has become a bit easier. For the past year, the Department of Health has been working on an online application process that will allow all health care professionals to apply online for an initial license and complete (and update as necessary) a practitioner profile mandatory for certain professions. The process is user friendly and convenient and even allows you to pay for your initial application utilizing a credit card, debit card or e-check. You will also be able to upload many of the documents required to complete your initial application! Please go to the initial application link below to begin the online process.
- Application for Licensure as a Dental Hygienist (PH-0915)
- Application for Dental Hygienists to Practice Under Written Protocol (PH-4187)
- Administration of Local Anesthesia Certification Application (PH-3966)
- Certification of Successful Completion of the Injections Required for the Administration of Local Anesthesia Certification (PH-4005)
- Application for Special Volunteer License for Dentists and Dental Hygienists (PH-3891)
Dental Assistants
► Applying for initial licensure from your professional licensing board has become a bit easier. For the past year, the Department of Health has been working on an online application process that will allow all health care professionals to apply online for an initial license and complete (and update as necessary) a practitioner profile mandatory for certain professions. The process is user friendly and convenient and even allows you to pay for your initial application utilizing a credit card, debit card or e-check. You will also be able to upload many of the documents required to complete your initial application! Please go to the initial application link below to begin the online process.
- Application for Registration as a Dental Assistant (PH-3166)
- Certification Application for Registered Dental Assistants (PH-3967)
Certification Courses
- Application for Board Approval of a Certification Course in Administration Of Local Anesthesia (PH-3968)
- Application for Board Approval of a Certification Course in Dental Radiology (PH-3965)
- Application for Board Approval of a Certification Course in Administration and Monitoring Nitrous Oxide (PH-3864)
- Application for Board Approval of a Certification Course in Coronal Polishing (PH-3865)
- Application for Board Approval of a Certification Course in Monitoring Nitrous Oxide (PH-3868)
- Application for Board Approval of a Certification Course in Prosthetic Functions (PH-3863)
- Application for Board Approval of a Certification Course in Restorative Functions (PH-3866)
- Application for Board Approval of a Certification Course in Sealant Application (PH-3862)