21 NCAC 16F .0104 CERTIFICATE OF REGISTRATION
(a) Each professional entity shall submit an application for a certificate of registration on the form available on the Board's website, www.ncdentalboard.org, and shall include the following information:
(1) name of the company;
(2) street address of the company;
(3) mailing address of the company, if different from the street address;
(4) email address of the company;
(5) name, address, and dental license number of each shareholder or member, and each dentist to be employed by the company once it is registered;
(6) name, address, and occupation of each corporation director and officer, or each limited liability company manager; and
(7) disclosure of any disciplinary action taken by or investigation pending before the Board with respect to any licensed dentist identified as an incorporator, officer, director, shareholder, member, manager, or employee.
(b) The application shall be:
(1) signed and notarized in accordance with Rule .0110 of this Subchapter;
(2) accompanied by a statement of the capacity in which the person signs and the person's authority to submit the application on behalf of the professional entity;
(3) submitted to the Board with all the information listed in Paragraph (a) of this Rule; and
(4) accompanied by the registration fee of fifty dollars ($50.00).
(c) In addition to the requirements set out in Paragraphs (a) and (b) of this Rule, a certificate of registration shall not be issued until the Board receives a copy of the certificate of incorporation and articles of incorporation of the professional corporation or association, or a copy of the articles of organization of the professional limited liability company, accompanied by certification of filing from the Secretary of State as set forth in G.S. 55D-17.
(d) The initial certificate of registration shall remain effective for one year from the date of issuance, unless suspended or terminated as provided in G.S. 55B-13, and each subsequent renewal of the certificate shall be effective for a period of one year from the date of issue.
History Note: Authority G.S. 55B‑10; 57D-2-01; 57D-2-02; 90‑48;
Eff. September 3, 1976;
Readopted Eff. September 26, 1977;
Amended Eff. August 1, 2009; April 1, 1994; May 1, 1989;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018;
Amended Eff. July 1, 2022; September 1, 2020.