License Application Forms for Dentist

All applicants for licensure must initially submit Form 1 along with the $377 licensure and first registration fee. You must answer all questions and provide all information requested unless otherwise indicated. Failure to accurately complete all required parts of the application will delay its review. Additional forms below are required based on the licensure requirements of the profession. Do not use Form 1 to renew your existing license.

Continuing Your Application
If you have started an application within the past 30 days, and have not yet completed it, you can use this link to continue your application. You will need your Application ID, Social Security Number, and Date of Birth.

Upload Additional Documentation
If you have already completed an application, but you have additional documents or files to include in your previous submission, use this link to upload additional documentation. You will need your Application ID and Date of Birth.

This form must be submitted directly by the educational institution(s) you attended. The Office of the Professions will not accept this form if submitted by the applicant.

• Section I: Complete this section before sending the entire form to your school. Be sure to sign and date item 9.
• Section II: The Registrar must complete this section and return both pages of the form in an official school envelope with requested documents directly to the Office of the Professions at the address at the end of the form.

A transcript of all courses taken at the dental school and grades received must be attached for all graduates of non-registered or non-accredited programs. Additionally, the school must attach a transcript of all courses convalidated or accepted for transfer credit and the basis on which these subjects were convalidated, including the name of the institution from which credit was transferred. When studies were completed at more than one school, official records need to be sent to the Department from each school. Please photocopy the form as needed.

Complete this form if you hold, or ever held, a license or certificate to practice any profession* in any jurisdiction.

This form must be submitted directly by the licensing/certifying authority. The Office of the Professions will not accept this form if submitted by the applicant.

• Section I: Complete this section before sending the entire form to the licensing/certifying authority of each jurisdiction in which you are or have been licensed/certified. Be sure to sign and date item 8.
• Section II: The licensing/certifying authority must complete this section, sign, date and return both pages of the form directly to the Office of the Professions at the address at the end of the form.

NOTE: A Form 3 is not required for licenses/certificates issued by the New York State Education Department. Also, If the certification/verification documentation provided by a U.S. jurisdictions contains the same information requested in the Form 3, completion of a Form 3 for that jurisdiction is not necessary. For certification/verification documentation that does not contain the same information, a Form 3 will need to be completed for that jurisdiction.

*Profession is defined as professional titles licensed under New York State Education Law.

Only applicants who have not completed an approved residency program of at least one year's duration, are licensed in another jurisdiction and are seeking licensure by endorsement are required to complete this form.

Complete this form and send it to the Office of the Professions at the address at the end of the form. Be sure to sign and date item 5.

This form must be submitted directly by the endorsing dentist. The Office of the Professions will not accept this form if submitted by the applicant.

If you are seeking licensure by endorsement, complete items 1-4 of this form. Give the form to a dentist(s) licensed and in good standing in the jurisdiction(s) in which you are currently licensed to complete. The form must be submitted directly by the licensed dentist to the Office of the Professions at the address at the end of the form. You may need to have more than one affidavit submitted for comprehensive certification of the required two years of professional practice. Please photocopy the form as needed.

This form must be submitted directly by your residency program director. The Office of the Professions will not accept this form if submitted by the applicant.

• Section I: Complete this section before giving the entire form to your residency program director. Be sure to sign and date item 6.
• Section II: The residency program director of the residency program you completed must complete this section and return both pages of the form directly to the Office of the Professions at the address located at the bottom of the form.

As of January 1, 2010, dental residents in programs approved by the Commission on Dental Accreditation of the American Dental Association are no longer required to obtain a limited permit in order to practice in the residency program. Residents are required, however, to register annually with the Department and pay an annual fee of $105.00. Residents should contact the program’s residency director regarding the registration procedures.

• Section I: If you are applying for a limited permit, complete this section before having your prospective employer complete Section II or III, whichever is applicable. Your signature on Form 5 must be notarized by a Notary Public.
• Section II: If you are requesting the limited permit for instructing in dentistry, have your prospective employer complete Section II.
• Section III: If you are requesting the limited permit for an approved dental residency, have your prospective employer complete Section III.

Return the completed form with the $105 fee to the Office of the Professions at the address at the end of the form. If you did not complete the required coursework or training in the identification and reporting of child abuse as part of a New York State educational program, you must submit a certificate of completion from an approved provider or an exemption form (Form 1CE).

Remember that you must have your dental school submit a Certification of Professional Education (Form 2) before your limited permit application can be evaluated.

This form is not for all applicants. Use this form only if you are applying for an exemption to the requirement to complete training or coursework in the identification and reporting of child abuse because your practice does not involve professional contact with persons under the age of 18 and persons 18 or older with a handicapping condition who reside in a residential care school or facility.

This form is not for all applicants. Use this form only if you are physically incapable of performing CPR.

As of January 1, 2009, all dentists must receive and maintain certification in cardiopulmonary resuscitation (CPR). If a dentist is physically unable to perform CPR, he or she may request an exemption by submitting an application for exemption. The request must be accompanied by a statement from the professional treating the disability and a signed assurance naming another individual or individuals who will maintain CPR certification and be present in the office while the exempt dentist is seeing patients.

Only for use by directors of residency programs approved by the Commission on Dental Accreditation (CODA) of the American Dental Association. This form is to be submitted no later than 60 days after the start of a resident's program. An individual check for each eligible resident, made payable to the New York State Education Department in the amount of $105 should be attached to this form with the check number recorded in the appropriate column. This fee is payable annually for each academic year for the duration of the program as approved by CODA. Note: A Dental Education Record Form needs to be submitted for each resident whose dental degree is from a non-accredited institution (ie. dentists from schools outside the US or Canada.).

Use this form along with the Form 5R ONLY if the original dental degree was awarded from a non-accredited institution (ie. dentists from schools outside the US or Canada.). This form will be used as a preliminary review of the resident's education credentials. The Certification of Professional Education (Form 2) and official transcripts must be submitted directly to the Office of the Professions from the institution from which the dental degree was awarded, they will not be accepted if submitted by the applicant.

This form must be completed by each resident and submitted with the Residency Director’s Roster.

Important Notice: A New York State professional license is valid for life unless it is revoked, annulled, or suspended by the Board of Regents. To practice in New York State your professional license must be registered. If your registration has lapsed and you need to reregister, do not submit a Form 1.  Instead, visit https://www.op.nysed.gov/registration-renewal/online-registration-renewal. If your registration has lapsed for longer than 4 months, submit a Delayed Registration Application.

All applicants for licensure must initially submit Form 1 along with the $100 licensure and first registration fee. You must answer all questions and provide all information requested unless otherwise indicated. Failure to accurately complete all required parts of the application will delay its review. Additional forms below are required based on the licensure requirements of the profession. Do not use Form 1 to renew your existing license.

Continuing Your Application
If you have started an application within the past 30 days, and have not yet completed it, you can use this link to continue your application. You will need your Application ID, Social Security Number, and Date of Birth.

Upload Additional Documentation
If you have already completed an application, but you have additional documents or files to include in your previous submission, use this link to upload additional documentation. You will need your Application ID and Date of Birth.

All applicants for licensure must initially submit Form 1 along with the $100 licensure and first registration fee. You must answer all questions and provide all information requested unless otherwise indicated. Failure to accurately complete all required parts of the application will delay its review. Additional forms below are required based on the licensure requirements of the profession. Do not use Form 1 to renew your existing license.

Continuing Your Application
If you have started an application within the past 30 days, and have not yet completed it, you can use this link to continue your application. You will need your Application ID, Social Security Number, and Date of Birth.

Upload Additional Documentation
If you have already completed an application, but you have additional documents or files to include in your previous submission, use this link to upload additional documentation. You will need your Application ID and Date of Birth.

All applicants for licensure must initially submit Form 1 along with the $100 licensure and first registration fee. You must answer all questions and provide all information requested unless otherwise indicated. Failure to accurately complete all required parts of the application will delay its review. Additional forms below are required based on the licensure requirements of the profession. Do not use Form 1 to renew your existing license.

Continuing Your Application
If you have started an application within the past 30 days, and have not yet completed it, you can use this link to continue your application. You will need your Application ID, Social Security Number, and Date of Birth.

Upload Additional Documentation
If you have already completed an application, but you have additional documents or files to include in your previous submission, use this link to upload additional documentation. You will need your Application ID and Date of Birth.

The form appropriate to the type of certification you are requesting must be completed and submitted by the institution where you met the requirement. The Office of the Professions will not accept the form if it is submitted by the applicant.

• Section I: Complete this section of the form before sending it to the educational institution. Be sure to sign and date item 8 and include any fee required by the institution.
• Section II: The Registrar or appropriate official must complete this section and return the form directly to the Office of the Professions at the address at the end of the form.

You must complete this form if you are:

• a dentist and have had any mortality or irreversible morbidity occurring during or within 48 hours following, or otherwise related to, the administration of conscious (moderate) sedation or deep sedation or general anesthesia; or
• are applying for an anesthesia certificate via endorsement and you have ever had any patients with irreversible morbidity or mortality due to the sedation provided by you.

Complete the entire form. Be sure to sign and date the certification before submitting the completed form along with any other documentation to the Office of the Professions at the address at the end of the form.