Dentist Licensure Reinstatement of a Lapsed License

Applications are only accepted online.  In order to submit your reinstatement application online, you will need to know your current user ID and password in DPH's system.  If you do not recall your user ID and password, you can use the recovery options as well as the 'Register' link.  If you use the 'Register' link, please disregard the language under 'PLEASE READ' and select 'NEXT' button at the bottom of the page.  On the next screen, you will need to match your first name, last name and the last 4 digits of your SSN and create a new password and validate your email address.  Please select this link to submit your online application.  The application fee is $579.75 (note that $4.75 covers the cost of querying the National Practitioner Data Bank).

 

As part of the online application, you will upload a recent photo of yourself, a current curriculum vitae (CV) including a synopsis of professional activity since completion of dental school and certificates of completion of 12 hours of continuing education completed within the one-year period from the date of application.

 

The applicant shall arrange for the following documents to be submitted directly to DPH from the source:

 

A letter from the appropriate authority confirming your most recent employment; including dates and an overall evaluation of your ability to practice dentistry with reasonable skill and safety.  If you are in private practice, a letter from another dentist or physician with whom you have referred patients.  Such letter shall indicate dates of the referral relationship and an evaluation of your ability to practice dentistry with reasonable skill and safety; and

 

If applicable, verification of any out-of-state license held, current or expired, submitted directly to this office from the source.  Please contact the state prior to submitting a request as most states charge a fee for completion of the form,

 

Please note that an application from a dentist who has been out of the clinical practice of dentistry for longer than six (6) months is referred to the Connecticut State Dental Commission for the that body's recommendation regarding the applicant's eligibility for reinstatement.   The Commission meets quarterly.

 

All supporting documents should be mailed directly from the source to:

 

Connecticut Department of Public Health

Dental Licensing

410 Capitol Ave., MS #12 APP

P.O. Box 340308

Hartford, CT 06134

Phone: (860) 509-7603

Fax:  (860) 707-1929

Email: dph.dentalteam@ct.gov