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Board of Dental Examiners
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Dental Applications

IMPORTANT INFORMATION:
Professional Background Information Services has changed their address to the following.

Professional Background Information Services
23460 North 19th Avenue, Suite 225
Phoenix, AZ 85027

Application for a Courtesy License to Practice Dentistry or Dental Hygiene, #08-0005, Revised 07/19/10.
Application for Dental Licensing by Credentials,
#08-4159, Revised 04/09/13.
Application for Dental License by Examination Level II,
#08-0074, Revised 04/09/13.
Application for Dental License by Examination Level III,
#08-4165, Revised 04/09/13.
Application for Obtaining a Permit to Administer Parenteral Sedation, #08-4172, Revised 12/11/12.
Application for Obtaining a Permit to Administer General Anesthesia, #08-4618, Revised 01/24/13.
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Applications may be viewed and printed with Adobe Acrobat Reader 6.0 or higher. If you do not have Adobe Acrobat Reader 6.0 or higher, please click on the Adobe logo and download the free software now. If you are unable to view or download an application, please contact us by telephone or e-mail. Providing your complete mailing address will enable us to mail you the application.

Other application forms may be mailed to you or picked up at a division office. Completed applications must be signed and submitted to the division with the appropriate fees.

 

 

 

 
 

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