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/Institutions/University-of-Maryland-School-of-Dentistry/json/Clinic-Manual/Clinic-Manual-local.json

/Institutions/University-of-Maryland-School-of-Dentistry/json/Clinic-Manual/Clinic-Manual.json

CDS Licensure Procedure

Subject: III. Clinical - C. Credentialing and Licensure

Effective Date: September 2016

Reviewed and/or Revised: 09/01/2017

Policy/Procedure: CDS Licensure Procedure

All Clinical Faculty who prescribe, need to have their own personal Maryland CDS License. A copy of the CDS License needs to be on file with the Director of Medical Credentialing and Quality Assurance.

If the Faculty provider does not have a CDS License and needs to obtain a CDS License, the faculty needs to complete an application for a Maryland Controlled and Dangerous Substance (CDS) License. You will need to complete and send in the CDS Application Form first prior to completing a DEA Application form. Then complete this form. Instructions for completing the Maryland Controlled and Dangerous Substance (CDS) license:

Section 1 A: select DDS or DMD

Section 1 B: check New

Section 1 C: Fee Exempt Information:

Agency:	University of Maryland School of Dentistry
Division:	Office of the Dean
Address:	650 W. Baltimore Street, Suite 6402, Baltimore, MD 21201
Telephone:	410-706-7461
Certifier Name:	Dr. David George
Title of Certifier:	Chief of Staff

NOTE: Dr. George will need to sign and date the form. Please send your completed and signed form to the Director of Medical Credentialing who will note the Agency Unit Code on the form and obtain Dr. George’s signature.

Section 2: Complete A through F.

Section 3:

1. Note your Maryland Dental License number
2. Federal DEA Number – put “pending” if you do not yet have a DEA License
3. Social Security or Tax ID#. – Put your social security number since this license is for you the provider.

Answer D, E, F and G.

Sign and date your application

Make a copy of the application for your records and send it Certified Mail so the application can be tracked.

You will apply for you CDS License BEFORE applying for you DEA License. You may check the status of your CDS application by checking the link below:

https://health.maryland.gov/cdssearch/sitepages/home.aspx

Enter your name to see if you have been issued a CDS License number. Once you have your CDS License number, you can input this number onto your DEA License application.