Get Application To Remove Disabled Status From License

This guide provides detailed instructions on how to accurately fill out the application to remove disabled status from your dental license. Follow the steps below to ensure your application is completed correctly and submitted successfully.

Follow the steps to complete your application effectively.

1. Click the ‘Get Form’ button to access the application form and open it for editing.
2. Input your full name in the designated field labeled 'Name of Licensee'. Ensure the spelling is accurate.
3. Complete the 'Full Address' section, including street address, city, state, and zip code, ensuring that all information is entered clearly.
4. Enter your birthdate in the specified format to avoid any processing issues.
5. Locate the 'License Number' field and input your current dental license number precisely.
6. Indicate your wish to remove the disabled status by checking the appropriate box or responding where prompted.
7. Attach proof of completed continuing education by submitting the required documentation with your application.
8. Complete the section requiring your attending physician's information, including their printed name, telephone number, address, and license number.
9. Ensure your attending physician signs and dates the certification indicating that you no longer have a disability preventing safe dental practice.
10. Sign and date the applicant's certification statement to affirm that the information provided is true and correct.
11. Review the application for any errors or missing information before submission.
12. Once all sections are complete and verified, choose to save changes, download, print, or share your completed application as necessary.

Complete your application to remove disabled status online today for a smoother licensing process.