Board of Dentistry
665 Mainstream Drive
Nashville, TN 37243
Applications
Dentists, Dental Hygienists, and Registered Dental Assistants
- Declaration of Citizenship (PH-4183)
- Declaration of Eligibility for Expedited Licensure Process for a Military Member (PH-4279)
- Declaration of Eligibility for Expedited Licensure Process for a Spouse of Military Member (PH-4280)
- Name and Address Change Request (PH-3619)
- Retirement - Affidavit of Retirement From Practice in Tennessee (PH-3460)
- Course Evaluation Form for Individual Licensees/Registrants Seeking Approval of Continuing Education Courses (PH-3867)
- Application for Duplicate License (PH-3872)
- Reinstatement/Reactivation Application (PH-3870)
- Jurisprudence Exam
Dentists
► Applying for initial licensure from your professional licensing board has become a bit easier. For the past year, the Department of Health has been working on an online application process that will allow all health care professionals to apply online for an initial license and complete (and update as necessary) a practitioner profile mandatory for certain professions. The process is user friendly and convenient and even allows you to pay for your initial application utilizing a credit card, debit card or e-check. You will also be able to upload many of the documents required to complete your initial application! Please go to the initial application link below to begin the online process.
- Application Instructions for Licensure as a Dentist (by exam, by criteria, by dual degree and for limited or limited educational licenses)
- Application for Licensure as a Dentist (PH-3168) NOTE: Effective August 12, 2019, the clinical examination must include a prosthetic component, a periodontal component, an endodontic component, and a live human patient anterior and posterior restorative component. October 10, 2019 - Policy Statement on Dental Examination Requirements
Dentists who are graduating in 2020 will not be required to have completed a live human patient anterior and posterior restorative component during the clinical examination pursuant to Executive Order 36 signed by Governor Lee on May 12, 2020. In response to questions regarding the periodontal portion of the exam, Rule 0460-02-.05 does not currently require the periodontal portion of the exam to be completed in person. The rule regarding examination requirements can be found at https://publications.tnsosfiles.com/rules/0460/0460-02.20190812.pdf
- Application for Licensure as a Dentist by Criteria (Reciprocity) (PH-3802)
- Application for Limited and Limited Educational Licensure (PH-3592)
- Mandatory Practitioner Profile Questionnaire for Licensed Health Care Providers (PH-3585)
- Application Instructions for Conscious Sedation Permit (PH-2865)
- Application Instructions for Deep Sedation/General Anesthesia Permit (PH-3172)
- Application for Specialty Certification (PH-3873)
- Application for Inactive Pro Bono Dental License (PH-3892)
- Application for Special Volunteer License for Dentists and Dental Hygienists (PH-3891)
- Jurisprudence Exam
- Dental Facility Permit Application (PH 4348)
- List of Approved Dental Facility Inspectors
Dental Hygienists
► Applying for initial licensure from your professional licensing board has become a bit easier. For the past year, the Department of Health has been working on an online application process that will allow all health care professionals to apply online for an initial license and complete (and update as necessary) a practitioner profile mandatory for certain professions. The process is user friendly and convenient and even allows you to pay for your initial application utilizing a credit card, debit card or e-check. You will also be able to upload many of the documents required to complete your initial application! Please go to the initial application link below to begin the online process.
- Application Instructions for Licensure as a Dental Hygienist (by exam, by criteria and for limited educational licenses)
- Application for Licensure as a Dental Hygienist (PH-0915)
- Application for Dental Hygienists to Practice Under Written Protocol (PH-4187)
- Administration of Local Anesthesia Certification Application (PH-3966)
- Certification of Successful Completion of the Injections Required for the Administration of Local Anesthesia Certification (PH-4005)
- Application for Special Volunteer License for Dentists and Dental Hygienists (PH-3891)
- Jurisprudence Exam
Dental Assistants
► Applying for initial licensure from your professional licensing board has become a bit easier. For the past year, the Department of Health has been working on an online application process that will allow all health care professionals to apply online for an initial license and complete (and update as necessary) a practitioner profile mandatory for certain professions. The process is user friendly and convenient and even allows you to pay for your initial application utilizing a credit card, debit card or e-check. You will also be able to upload many of the documents required to complete your initial application! Please go to the initial application link below to begin the online process.
- Application Instructions for Registration as a Dental Assistant
- Application for Registration as a Dental Assistant (PH-3166)
- Certification Application for Registered Dental Assistants (PH-3967)
- Sealant Certification Application for Registered Dental Assistants (PH-3871)
- Certification of Sealant Placement During Externship (PH 4262)
- Jurisprudence Exam
Programs and Certification Courses
- Application for Board Approval of a Certification Course in Administration Of Local Anesthesia (PH-3968)
- Application for Board Approval of a Certification Course in Dental Radiology (PH-3965)
- Application for Board Approval of a Certification Course in Administration and Monitoring Nitrous Oxide (PH-3864)
- Application for Board Approval of a Certification Course in Coronal Polishing (PH-3865)
- Application for Board Approval of a Certification Course in Monitoring Nitrous Oxide (PH-3868)
- Application for Board Approval of a Certification Course in Prosthetic Functions (PH-3863)
- Application for Board Approval of a Certification Course in Restorative Functions (PH-3866)
- Application for Board Approval of a Certification Course in Sealant Application (PH-3862)
- Application for Board Approval of a Registered Dental Assisting Program