Get Dental Expired License (1-3 Years) Activation Application

This guide provides a clear, step-by-step approach for users to complete the Dental Expired License (1-3 Years) Activation Application online. With careful attention to detail, you will navigate the process efficiently and accurately.

Follow the steps to complete your application effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your demographic information in the designated fields. This includes your Social Security Number, which is required by law. If you do not possess a Social Security Number, contact the Customer Service Center for assistance.
3. Provide your full legal name, including first, middle, and last names. Ensure that the name listed is consistent with official documents, such as your birth certificate or marriage certificate.
4. Specify your birth date using the format mm/dd/yyyy. This detail is crucial for identity verification.
5. Enter your permanent mailing address, including city, state, zip code, county, and country. This address will serve as the primary contact point for any correspondence regarding your license.
6. You may also enter your phone, fax, and cell numbers, as well as your email address for further communication.
7. Indicate if you have ever been known by any other names. If yes, list those names, as this information may be necessary for processing your application.
8. In the section for other licenses or certifications, list any credentials you have held since your Washington State credential expired, including the state, profession, and year issued, ensuring to maintain the correct order of dates.
9. Outline your professional experience in the provided fields, detailing your work history since your last active credential, along with the start and end dates for each position.
10. Complete the attestation sections, confirming that you have not faced disciplinary actions that restrict your professional practice and that you have met continuing education requirements.
11. Sign and date the applicant's attestation, declaring the accuracy of your application and your awareness of the Department of Health's requirements.
12. Review your completed application for any errors or missing information. After finalizing your application, save your changes, and then proceed to download, print, or share the form as needed.

Complete your Dental Expired License Activation Application online today to ensure a smooth renewal process.