21 NCAC 16D .0104         APPLICATION FOR PROVISIONAL LICENSE

(a)  An applicant for a provisional dental license shall submit to the Board:

(1)           a notarized application form provided by the Board at www.ncdentalboard.org that includes the information and materials required by 21 NCAC 16B .0301(a);

(2)           the nonrefundable provisional licensure fee set forth in 21 NCAC 16M .0101;

(3)           a letter from a North Carolina licensed dentist stating he or she will supervise the applicant; and

(4)           a statement disclosing and explaining any investigations, malpractice claims, or state or federal agency complaints, judgments, or settlements that are related to licensure and are not disclosed elsewhere in the application.

(b)  In addition to the requirements of Paragraph (a) of this Rule, an applicant for a provisional license shall satisfy the requirements in 21 NCAC 16B .0501(b).

(c)  The Board shall receive all items set forth in Paragraphs (a) and (b) of this Rule and the applicant's passing scores on all examinations required by 21 NCAC 16B .0303 for the application to be complete. Applications that are not completed within one year of being submitted to the Board shall be disregarded as expired without a refund of the application fee.

(d)  An applicant for a provisional license shall pass written examinations as set out in 21 NCAC 16B .0303(a). Applicants who do not pass the written examination after three attempts within one year may not reapply for provisional licensure.

(e)  Any applicant who changes his or her address shall notify the Board office in writing within 10 business days.

(f)  Any license obtained through fraud or by any false representation shall be revoked.

History Note:        Authority G.S. 90-29.3; 90-41(a);

Eff. September 3, 1976;

Readopted Eff. September 26, 1977;

Temporary Amendment Eff. January 1, 2003;

Amended Eff. December 1, 2014; January 1, 2004;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;

Amended Eff. March 1, 2020.