Nevada Administrative Code › Chapter 631 - Dentistry and Dental Hygiene › LICENSING › Section 631.030 - Provision of certain information and documentation by applicant for licensure; examination for certain licenses

Current through June 11,
			 2024
1. An applicant for
			 licensure must provide the following information and documentation in his or
			 her application:
(a) The date and place of
			 his or her birth;
(b) Certification
			 of graduation from an accredited dental school or college or from an accredited
			 school or college of dental hygiene, whichever is applicable;
(c) Whether he or she has applied for similar
			 licensure in another state or a territory of the United States or the District
			 of Columbia and, if so, the name of the state or territory of the United States
			 or the District of Columbia, the date and the result of his or her
			 application;
(d) If he or she has
			 practiced dentistry or dental hygiene in another state or a territory of the
			 United States or the District of Columbia, certification from the licensing
			 authority of each state or territory of the United States or the District of
			 Columbia in which he or she has practiced or is practicing that he or she is in
			 good standing and that there are not any disciplinary proceedings affecting his
			 or her standing pending against him or her in the other state or territory of
			 the United States or the District of Columbia;
(e) Whether he or she has terminated or
			 attempted to terminate a license from another state or territory of the United
			 States or the District of Columbia and, if so, the reasons for doing
			 so;
(f) If he or she is not a
			 natural born citizen of the United States, a copy of his or her certificate of
			 naturalization or other document attesting that he or she is legally eligible
			 to reside and work in the United States;
(g) All scores obtained on the examination in
			 which he or she was granted a certificate by the Joint Commission on National
			 Dental Examinations and the date it was issued;
(h) Whether he or she has ever been convicted
			 of a crime involving moral turpitude or has entered a plea of nolo contendere
			 to a charge of such a crime and, if so, the date and place of the conviction or
			 plea and the sentence, if any, which was imposed;
(i) Whether he or she has had any misdemeanor
			 or felony convictions and, if so, any documents relevant to any misdemeanor or
			 felony convictions;
(j) Whether he
			 or she has been held civilly or criminally liable in this State, another state
			 or territory of the United States or the District of Columbia for misconduct
			 relating to his or her occupation or profession;
(k) Whether he or she has a history of
			 substance abuse and, if so, any documents relevant to the substance
			 abuse;
(l) Whether he or she has
			 been refused permission to take an examination for licensure by this State, any
			 other state or territory of the United States or the District of Columbia, or
			 any regional testing agency recognized by the Board and, if so, any documents
			 relevant to the refusal;
(m)
			 Whether he or she has been denied licensure by this State, any other state or
			 territory of the United States or the District of Columbia and, if so, any
			 documents relevant to the denial;
(n) Whether he or she has had his or her
			 license to practice dentistry or dental hygiene suspended, revoked or placed on
			 probation , or has otherwise been disciplined concerning his or her license to
			 practice dentistry or dental hygiene, including, without limitation, receiving
			 a public reprimand, in this State, another state or territory of the United
			 States or the District of Columbia and, if so, any documents relevant to the
			 suspension, revocation , probation or other discipline;
(o) A copy of current certification in
			 administering cardiopulmonary resuscitation;
(p) Whether he or she is currently involved
			 in any disciplinary action concerning his or her license to practice dentistry
			 or dental hygiene in this State, another state or territory of the United
			 States or the District of Columbia and, if so, any documents relevant to the
			 reprimand or disciplinary action;
(q) Two sets of certified fingerprint cards
			 and an authorization form allowing the Board to submit the fingerprint forms to
			 law enforcement agencies for verification of background information;
(r) Whether he or she has any claims against
			 him or her or has committed any actions that would constitute unprofessional
			 conduct pursuant to NRS 631.3475, as amended by
			 section 6 of Senate Bill No. 101, chapter 238, Statutes of Nevada 2017, at page
			 1256, and section 25 of Assembly Bill No. 474, chapter 605, Statutes of Nevada
			 2017, at page 4414, or NAC
			 631.230;
(s) An application form that he or she has
			 completed and signed which:
(1) Is furnished
			 by the Board; and
(2) Includes,
			 without limitation, a properly executed request to release
			 information;
(t) If
			 applicable, the statement and proof required by subsection 3;
(u) Evidence that he or she is eligible to
			 apply for a license to practice:
(1)
			 Dentistry pursuant to
			 NRS
			 631.230; or
(2) Dental hygiene pursuant to
			 NRS
			 631.290;
(v) The statement required by
			 NRS
			 425.520; and
(w) Any other information requested by the
			 Board.