Get 2020 Form Wa Doh 646-164 Fill Online, Printable, Fillable ...

Filling out the 2020 Form WA DOH 646-164 is a crucial step for individuals seeking to activate their expired dentist license. This guide provides clear and structured instructions to assist users in completing the form accurately and efficiently.

Follow the steps to fill out the form correctly.

1. Click ‘Get Form’ button to access the form online and open it in your preferred editor.
2. Begin with the Demographic Information section. Provide your National Provider Identifier Number (NPI) if available, and your Social Security Number (SSN). Remember, if you do not have an SSN, review the Declaration of No Social Security Number Form for alternative options.
3. Fill in your full legal name, as listed on official documents. Ensure you complete this part accurately to avoid any processing delays.
4. Next, provide your birth date in the specified format (mm/dd/yyyy), and then enter your current address, including city, state, zip code, county, and country.
5. Input your phone numbers, including your phone, fax, and cell numbers if available. Also, provide your email address for further correspondence.
6. Indicate whether you are known by any other names. If so, list those names in the space provided.
7. Complete the section on Other License, Certification, or Registration by listing all relevant credentials in chronological order.
8. Document your Professional Experience by detailing relevant work experience since your last Washington State credential.
9. Certify your Disciplinary Action Attestation by affirming you have not faced any actions against your professional practice that could affect your eligibility.
10. Complete the Continuing Education Attestation section, certifying you have fulfilled all required continuing education criteria.
11. Sign and date the Applicant's Attestation to confirm the accuracy of all provided information.
12. Finally, review your completed form for accuracy, save changes, and decide whether to download, print, or share the form as necessary.

Start filling out your application online today to ensure a smooth process for activating your dentist license.