Department of Health
John J. Dreyzehner, MD, MPH, Commissioner
Board of Dentistry
Applications
Dentists, Dental Hygienists, and Registered Dental Assistants
- Declaration of Citizenship (PH-4183)
- Name and Address Change Request (PH-3619)
- Affidavit of Retirement From Practice in Tennessee (PH-3460)
- Course Evaluation Form for Individual Licensees/Registrants Seeking Approval of Continuing Education Courses (PH-3867)
- Application for Duplicate License (PH-3872)
- Reinstatement/Reactivation Application (PH-3870)
Dentists
- Application for Licensure as a Dentist (PH-3168)
- Application for Licensure as a Dentist by Criteria (Reciprocity) (PH-3802)
- Application for Limited and Limited Educational Licensure (PH-3592)
- Mandatory Practitioner Profile Questionnaire for Licensed Health Care
Providers (PH-3585) - Application Instructions for Conscious Sedation Permit (PH-2865)
- Application Instructions for Deep Sedation/General Anesthesia Permit (PH-3172)
- Application for Specialty Certification (PH-3873)
- Application for Inactive Pro Bono Dental License (PH-3892)
- Application for Special Volunteer License for Dentists and Dental Hygienists (PH-3891)
Dental Hygienists
- Application for Dental Hygienists to Practice Under Written Protocol (PH-4187)
- Application for Licensure as a Dental Hygienist (PH-0915)
- Administration of Local Anesthesia Certification Application (PH-3966)
- Certification of Successful Completion of the Injections Required for the Administration of Local Anesthesia Certification (PH-4005)
- Application for Special Volunteer License for Dentists and Dental Hygienists (PH-3891)
Dental Assistants
- Application for Registration as a Dental Assistant (PH-3166)
- Certification Application for Registered Dental Assistants (PH-3967)
- Accommodations for Examinees with Disabilities Eligibility Questionnaire (PH-3305)
Certification Courses
- Application For Board Approval Of A Certification Course In Administration Of Local Anesthesia
- Application For Board Approval Of A Certification Course In Dental Radiology
- Application for Board Approval of a Certification Course in Administration and Monitoring Nitrous Oxide (PH-3864)
- Application for Board Approval of a Certification Course in Coronal Polishing (PH-3865)
- Application for Board Approval of a Certification Course in Monitoring Nitrous
Oxide (PH-3868) - Application for Board Approval of a Certification Course in Prosthetic
Functions (PH-3863) - Application for Board Approval of a Certification Course in Restorative
Functions (PH-3866) - Application for Board Approval of a Certification Course in Sealant Application (PH-3862)
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Governor Bill Haslam
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