Get Wa Doh 646-164 2012

This guide provides comprehensive instructions on filling out the WA DOH 646-164 form for activating a dentist's expired license. It is designed to assist users with varying levels of experience in document management.

Follow the steps to complete the WA DOH 646-164 form successfully.

1. Press the ‘Get Form’ button to access the WA DOH 646-164 form, where you can begin filling it out in the available editor.
2. Begin with the demographic information section. Enter your social security number, legal name (first, middle, last), birth date (month, day, year), and place of birth (city, state, country).
3. Provide your address, ensuring to include the city, state, zip code, county, and country. This address will be the permanent one on file unless updated.
4. Complete the contact details by entering your phone number, fax number, cell number, and email address if available.
5. Indicate if you have been known by any other name(s) by answering the appropriate yes/no option and including any relevant names.
6. In the previous credentialing section, list all credentials held since last being credentialed in Washington State, starting with the most recent.
7. Detail your professional experience since your last credential, also starting with your most recent position. Provide all necessary dates for employment.
8. Complete the attestation sections, including AIDS education and training, disciplinary action, and continuing education, signing and dating them where required.
9. In the applicant’s attestation, declare under penalty of perjury that you have provided accurate information, signing and dating the form.
10. Once all fields are completed, review your form for accuracy. Save your changes, download or print the completed form, and prepare it for submission.

Complete your documents online today and ensure your dental practice is aligned with the latest requirements.