The applicant is responsible for obtaining and furnishing to the DQAC all materials required to establish eligibility for a license without examination. In addition to the requirements defined in WAC 246-817-110
the following documentation must be provided:
(1) A statement by the applicant as to whether the applicant has been the subject of any disciplinary action in the state(s) of licensure and whether the applicant has engaged in unprofessional conduct as defined in RCW 18.130.180
(2) A statement by the applicant that they are not an impaired practitioner as defined in RCW 18.130.170
(3) A certification by the state board(s) of dentistry (or equivalent authority) that the applicant was issued a license, registration, certificate or privilege to practice dentistry, without restrictions, and whether the applicant has been the subject of final or pending disciplinary action.
(4) Documentation to substantiate that standards defined in WAC 246-817-140
have been met.
(5) Proof that the applicant is currently engaged in the practice of dentistry, in another state as demonstrated by the following information:
(a) Address of practice location(s);
(b) Length of time at the location(s);
(c) A letter from all malpractice insurance carrier(s) defining years when insured and any claims history;
(d) Federal or state tax numbers;
(e) DEA numbers if any;
Dentists serving in the United States federal services as described in RCW 18.32.030
(2), for the period of such service, need not provide (a) through (e) of this subsection, but must provide documentation from their commanding officer regarding length of service, duties and responsibilities including any adverse actions or restrictions. Such dental service, including service within the state of Washington, shall be credited toward the dental practice requirement.
Dentists employed by a dental school approved by the DQAC for the period of such dental practice, need not provide (a) through (e) of this subsection, but must provide documentation from the dean or appropriate administrator of the institution regarding the length and terms of employment and their duties and responsibilities, and any adverse actions or restrictions. Such dental practice, including practice within the state of Washington, shall be credited toward the dental practice requirement. Dental practice within a residency program shall be credited toward the dental practice requirement. A license may be revoked upon evidence of misinformation or substantial omission.
All information must be completed and received within one hundred eighty days of receipt of the initial application. Only completed applications will be reviewed by the DQAC, or its designee(s) at the next scheduled DQAC meeting or at other intervals as determined by the DQAC.
[Statutory Authority: RCW 18.32.0365 and 18.32.215. 08-23-017, § 246-817-135, filed 11/6/08, effective 12/7/08. Statutory Authority: RCW 18.32.035. 95-21-041, § 246-817-135, filed 10/10/95, effective 11/10/95.]