When to File

The application for Dentist-FQHC Provisional license is a combined application for both a Dentist-FQHC Provisional license and Dentist license. Submit the application only if you are a dentist who is contracted to practice at a Federally Qualified Health Center (FQHC) in Delaware. The Dentist-FQHC Provisional license allows you to practice dentistry in Delaware

• before you have passed the three examinations required for full Dentist licensure
• only at the FQHC named on the license
• only under the general supervision of a Delaware-licensed dentist

Information about the Dentist-FQHC Provisional License

To receive a Dentist-FQHC Provisional license, you must meet all requirements for full Dentist licensure except the examination requirements. Dentist-FQHC Provisional license is valid for two years from the date it is issued.  It is not renewable. During the two-year period…

• You are allowed practice dentistry under the general supervision of a Delaware-licensed dentist at a FQHC.

• You must take the Delaware Practical Board Examination at least one time during the first year after your Dentist-FQHC Provisional license is issued.

• You must pass all three examinations required for full Dentist licensure – the Delaware Practical Board Examination, the Delaware Jurisprudence Examination, and the National Board Examination – before your Dentist-FQHC Provisional license expires. For more information about the exams, see the next section.

If you complete all examination requirements in the prescribed two-year period, the Dentist-FQHC Provisional license will transition into a Dentist license.

More Information about Required Examinations

All applicants for Dentist licensure, regardless of years in practice, are required to pass the Delaware Practical Board Examination in dentistry and the Delaware Jurisprudence Examination in addition to the National Board Examination.

• Delaware Practical Board Examination – You must take this at least once during the first year that your Dentist-FQHC Provisional license is active and you must pass it before your Dentist-FQHC Provisional license expires.
  • This exam is offered twice a year, at the beginning of January and June. The registration deadlines are December 1 for the January exam and May 1 for the June exam. To register for the exam, you must pay the examination fee by the deadline. The exam is limited to 18 candidates on each date.  For more information about the exam, click Practical Board Examination.
  • When the registration deadline passes, the Board office will mail an examination packet to registered candidates.  If you submit your exam fee after the deadline, you must include a late fee and you will receive an examination packet only after the Board office confirms availability of a seat.

• Delaware Jurisprudence Examination – You must pass the Jurisprudence Examination before your Dentist-FQHC Provisional license expires. It is an “open-book,” multiple-choice test based on the license law and the Board’s Rules and Regulations. The version for Dentists has 30 questions.

• National Board Examination – You must arrange for the Board office to receive the score report, sent directly to the Board office from the Joint Commission on National Dental Examinations before your Dentist-FQHC Provisional license expires.

Requirements for All Applicants

As the applicant, it is your responsibility – not the responsibility of the FQHC – to arrange for the Board to receive the documents listed below.   A Dentist-FQHC Provisional license will not be issued until the Board office receives all documents listed in this section. Do not begin working at a Delaware FQHC until a Dentist-FQHC Provisional license is issued to you.

• Submit completed, signed and notarized Application for Dentist-FQHC Provisional Licensure.

• Enclose payment for the following non-refundable fees by check or money order made payable to “State of Delaware.” You may combine the fees in one payment.
  • processing fee for Dentist-FQHC Provisional license
  • processing fee for Dentist license
  • examination fee for Practical Board Examination – You may submit this fee with your application or at a later time.  If you opt to wait, submit it no later than the examination registration deadline to ensure a seat and avoid the late exam fee.

• Complete the Criminal History Record Check Authorization form to request State of Delaware and Federal Bureau of Investigation criminal background checks.  Follow the instructions on the authorization form to arrange to be fingerprinted.

• Submit a copy of your employment contract with the FQHC.

• Arrange for the Board office to receive the completed, signed and notarized Statement of Supervision form included in this packet, sent directly from the FQHC to the Board office. Both the FQHC’s director and your supervising dentist must complete and sign the form in the presence of a notary.

• Enclose a copy of your current cardiopulmonary resuscitation (CPR) certification card.

• Arrange for the Board office to receive an official transcript from a Board-recognized undergraduate college or university, sent directly from the school to the Board office.

• Arrange for the Board office to receive an official transcript from your dental college or university, sent directly from the school to the Board office.  The transcript must show your degree and date of graduation. The dental college/university must be accredited by the Commission on Dental Accreditation of the American Dental Association (CODA).

• Arrange for the Board office to receive one of the following:
  • Proof (such as a letter from the sponsoring institution) that you have one year of experience as a dental intern in a CODA-accredited general practice residency sent directly from the sponsoring institution to the Board office.
  • Tax form W-2s or other proof that you have practiced actively for three years in another jurisdiction (state, U.S. territory or District of Columbia).
  • Proof (such as a letter from the sponsoring institution) that you have completed four or more years in a CODA-approved specialty residency, sent directly from the sponsoring institution to the Board office.
• If you have been in a CODA-approved specialty residency of less than four years, submit proof (such as a letter from the sponsoring institution) that the program you’re in
  • meets the goals, objectives, proficiencies and competencies set forth in Standard 2.4 of the CODA Accreditation Standards for Advanced Education Programs in General Practice Residency, ©2007 (Section 4.3 of the Board’s Rules and Regulations), and
  • includes a rotation of at least 70 hours in anesthesia and a rotation of at least 70 hours in medicine.

• Arrange for the Board office to receive license verification letters from each jurisdiction (state, U.S. territory or District of Columbia) where you are now, or have ever been, licensed, sent directly from the jurisdiction to the Board office.

• If you have ever been licensed in another jurisdiction, request a self-query from the National Practitioner Data Bank.  When you receive the report, send the original to the Board office.

• If you have never been issued a U.S. Social Security Number (SSN), submit a Request for Exemption from Social Security Number Requirement.

Requirements After Dentist-FQHC Provisional License Issuance

During the two-year period that your Dentist-FQHC Provisional License is valid, you must meet the examination requirements for a Delaware Dentist license. The Board may deny you full Dentist licensure if you fail to meet these requirements.

• If you opted not to submit the fee for the Delaware Practical Board Examination with your application, submit the examination fee by the registration deadline for the examination you wish to take.
  • Reminder:  You must take the exam at least once during the first year after issuance of the Dentist-FQHC Provisional License. The deadlines are December 1 for the January exam and May 1 for the June exam.
  • Reminder:  If you fail to submit the Examination fee by the registration deadline, enclose the non-refundable late exam fee.  You will be admitted to the exam only if a seat is still available.  If no seat is available, you will forfeit both the Examination fee and Late fee that you paid. To register for the next exam date, you must pay the Examination fee again; you cannot transfer it to a later examination date.

• Submit your completed, signed and notarized Jurisprudence Examination for Dentist Candidates.

• Arrange for the Board office to receive your National Board Examination score report, sent directly from the Joint Commission on National Dental Examinations to the Board office.  See Score Report Request.