Transcription of APPLICATION FOR RESTRICTED DENTAL LICENSE
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APPLICATION FOR RESTRICTED DENTAL LICENSE
RESTRICTED DENTAL LICENSE APPLICATION information and instructions 1 Rev. 8/7/2015 Louisiana State Board of Dentistry 365 Canal Street ~ Suite 2680 New Orleans, Louisiana 70130 Telephone ~ Fax APPLICATION FOR RESTRICTED DENTAL LICENSE NON-REFUNDABLE APPLICATION FEE $200 WELL-BEING PROGRAM FEE $25 REQUIREMENTS FOR LICENSURE Each applicant applying for a Louisiana RESTRICTED DENTAL LICENSE must 1. Complete and submit the entire notarized DENTAL LICENSE by examination APPLICATION 2. Successfully complete the Louisiana State Board of Dentistry jurisprudence examination 3.
Restricted dental license application information and instructions 3 Rev. 6/26/2018 DOCUMENTATION TO BE SUBMITTED WITH YOUR APPLICATION Please use the following checklists to ensure your application is complete prior to …
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