Healthy Communities

ASBDE - Applications & Renewals

Dentists
Dental License by Examination application
Dental License by Credentials application
Arkansas Speciality application
License Reinstatement form
Temporary Charitable License for Dentists
Moderate Sedation - application and facility permit
General/Deep Sedation - application and facility permit
Moderate Sedation - facility permit only
General/Deep Sedation - facility permit only
Mobile Dental Facility permit
Collaborative Care Permit application (note: must be approved by the Arkansas Department of Health's Office of Oral Health before applying with the Board. Contact the Office of Oral Health at 501-280-4051 for more information.)
Dental Corporation/Limited Liability Company Registration form
Fictitious Name Request form
Wall Certificate Remake form
Verification of Licensure Request form
Change Request form (to request a name, address, phone number, or email change)
Hygienists
Dental Hygiene License by Examination application
Dental Hygiene License by Credentials application
License Reinstatement form
Collaborative Care Permit application (note: must be approved byt the Arkansas Department of Health's Office of Oral Health before applying with the Board. Contact the Office of Oral Health at 501-280-4051 for more information.)
Local Anestesia Permit application
Wall Certificate Remake
Verification of License Request form
Change Request form (to request a name, address, phone number, or email change)
Assistants
Application for Registration of Dental Assistants
Expanded Duties Add-On for Registered Dental Assistants
Verification of Licensure Request form
Wall Certificate Remake
Change Request form (to request a name, address, phone number, or email change)

 

Renewals

Dentists & Registered Dental Hygienists:

Registered Dental Assistants

Public Health Accrediation Board
Arkansas Department of Health
© 2017 Arkansas Department of Health. All Rights Reserved. www.healthy.arkansas.gov
4815 W. Markham, Little Rock, AR 72205-3867
1-800-462-0599