234 CMR 4.04
Initial Dentist Licensure by Credentials
The Board may grant a license by credentials, without further professional examination, to
a dentist currently licensed in another jurisdiction, provided the applicant is of good moral
character, has met all eligibility requirements and has submitted the following information to the
Board:
(1) An accurate, complete and signed application on forms specified by the Board for that
purpose;
Office of Administration and Finance, unless waived in accordance with M.G.L. c. 112, ยง 1B;
(3) An original transcript with the college seal stating the degree granted and the date of issue
from a CODA-accredited dental school or any successor accrediting agency approved by the
Board, or a letter including the college's seal signed by the appropriate authority attesting to the
applicant's degree and date of graduation;
(4) A physician's statement made after an examination conducted within one year of the date
of application, attesting to the health of the applicant and to any impairments that may affect the
ability of the applicant to practice dentistry;
(5) Proof satisfactory to the Board of a minimum of five years of practice in dentistry or dental
education immediately preceding the application for licensure by credentials. An applicant may
include private practice; the practice of dentistry in the armed forces; federal, state, and
municipal programs; and intern and residency programs as part of this five year dental practice
requirement;
(6) Proof satisfactory to the Board that the applicant is currently licensed and in good standing
in another jurisdiction based on passing a Board-approved examination;
(7) Documentation of a passing score on each of the following exams:
(a) Parts I and II of the ADA National Board Examination;
(b) The CDCA or other state or regional examination approved by the Board; and
(c) Massachusetts Dental Ethics and Jurisprudence Examination or a Board-approved
successor examination.
(8) Certified letters of standing from all jurisdictions in which the applicant has been issued a
license to practice dentistry attesting to the standing of the applicant's license, including report
of any past or pending disciplinary action, or any pending complaints against the applicant;
(9) Letters of endorsement from two licensed dentists who are in good standing and familiar
with the applicant and his or her practice of dentistry which attest to the applicant's professional
competency and good moral character;
(10) Original report from the NPDB Self-query;
(11) Documentation of current BLS certification or CPR/AED certification, except an applicant
applying for an individual anesthesia permit shall provide documentation that complies with
234 CMR 6.00: Administration of Anesthesia and Sedation;
(12)
A statement disclosing any and all disciplinary action, civil or criminal action, or
restriction of privileges taken or filed against the applicant at any time after reaching the age of
majority and prior to the date of application, with supporting documentation as the Board may
require;
(13) A passport-size color photograph;
(14) Proof satisfactory to the Board of good moral character;
(15) An attestation, signed under pains and penalties of perjury, that the applicant has complied
with all state tax laws pursuant to M.G.L. c. 62C, ยง 49A and child support laws pursuant to
M.G.L. c. 119A, ยง 16(a); and
(16) Proof satisfactory to the Board of completion of training required pursuant to
M.G.L. c. 94C, ยง 18(e) as a condition precedent for obtaining licensure.