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Dental License and Limited Dental License Procedure

Subject: II. Clinical - C. Credentialing and Licensure

Effective Date: July 2016

Reviewed and/or Revised: 09/01/2017

In order for a Dentist provider to be in the UMSOD clinics either overseeing students or patients, and/or seeing patients, the Dentist would need to have an “active” Maryland Dental License on file with the Director of Medical Credentialing and Quality Assurance for UMSOD for Accreditation and Liability purposes.

The following is the protocol to be followed for obtaining a Limited Dental License:

  • Complete application front and back.
  • Sign and have the application notarized.
  • Enclose a written request from the hospital, sanitarium, or dental school to which the license to practice dentistry is to be limited.
  • Make sure you have enclosed the non-refundable fee made payable to the Maryland State Board of Dental Examiners. (NOTE: $225 fee if graduated from US or Canadian Dental School and $300 if from a Dental School outside of the US and Canada)
  • Enclose one photo that is between 2x2-inches and 3x3-inches with the required notarized Affidavit. Note: The photo will be affixed to your license. The photo must meet the following guidelines: taken within the last 2 years to reflect your current appearance; front view of full face from top of hair to shoulders; a natural expression; no hat; or head covering that obscures the hair or hairline, unless worn daily for religious purposes; no sunglasses, headphones, wireless hands-free devices or similar items; no other individuals or distractions in the photo. Photos copied or digitally scanned from driver’s licenses or other official documents are not acceptable. In addition, low quality vending machine or mobile phone photos are not acceptable. “Passport” photos are acceptable. Unacceptable photos will be returned and shall delay the issuance of your license.
  • Enclose a certified letter with the State seal affixed from each State in which you hold or have ever held a license verifying that the license is or was in good standing.
  • Enclose a letter from the hospital, sanitarium, or dental school which the license to practice dentistry is to be limited that indicates that you possess sufficient comprehension and communication skills in written and spoken English to enable you to adequately treat dental patients. NOTE: This letter will be obtained for you by the Director of Medical Credentialing and Quality Assurance.
  • If applicable, enclose evidence of legal name change, such as a marriage certificate or court documents.

If applying for a Limited Dental License For Graduates of Dental Schools Outside of the US/Canada, you will also need to:

  • Enclose evidence satisfactory to the Board that you have completed at least 2 years of formal general clinical training in a United States or Canadian accredited institution.
  • Enclose a copy of the degree or diploma, including an English translation (if applicable), issued to the applicant by the foreign dental school conferring it, properly authenticated by an official of that dental school authorized to make the authentication.
  • Enclose a copy, including an English translation (if applicable), of the subjects taken and the credits earned at the foreign dental school, properly authenticated by an official of that foreign dental school authorized to make the authentication.
  • Enclose two letters of recommendation that certify to the Board the good moral character as well as the applicant’s age, qualifications, background, and experience, if any.

APPLICATION FOR DENTAL LICENSURE FOR DENTISTS LICENSED IN ANOTHER STATE

  • Request that an original National Board score card be forwarded to the Maryland State Board of Dental Examiners.
  • Enclose a certified report from the North East Regional Board certifying that you have passed the ADLEX Diagnostic Skills Examination (DSE).
  • Enclose certified proof of your dental education, such as a copy of a diploma or a letter from the school? Please note that the original embossed school seal must be affixed to copies of transcripts and diplomas submitted to the Board.
  • Enclose certified letters with the state seal affixed from each state in which you hold or have ever held a license, verifying that the license is or was in good standing and that no disciplinary action has ever been taken against the license.
  • With respect to your work as a dentist attach a separate page identifying your employers for the 5 year period immediately preceding the date of your application beginning with your most recent employer. The document should include the following: (Please print or type) the name of your employer, name of your supervising dentist, street address, dates of employment, and the number of hours worked for each employer. If you owned your own dental practice please indicate when appropriate.
  • Enclose documentation of legal name change (i.e. marriage certificate) if the documents sent with the application are in another name.
  • Enclose the Maryland State Jurisprudence Examination and the notarized affidavit along with the $50.00 non-refundable fee in a check or money order made payable to the Maryland State Board of Dental Examiners.

PATH 1 CANDIDATES ONLY:

  • Enclose certified examination scores from the North East Regional Board for the ADLEX.

PATH 2 CANDIDATES ONLY:

  • Enclose evidence that you have an active license to practice dentistry in a state other than Maryland.
  • Enclose evidence that you were granted a license in another state after having passed an examination with a clinical component as a requirement for licensure in another state.
  • Enclose an affidavit indicating that you have been actively practicing dentistry for at least 5 years, and that during the 5 year period preceding you application you have been actively engaged in practicing dentistry for at least 850 hours on average per year for a total of at least 4,250 hours.

MAIL APPLICATION AND SUPPORTING DOCUMENTS TO:

Maryland State Board of Dental Examiners

The Benjamin Rush Building, Spring Grove Hospital Center

55 Wade Avenue

Catonsville, MD 21228

ATTN: Licensing Unit

Send your completed application and check to the Director of Medical Credentialing who will send your completed application to the MSBDE via overnight mail.