North Carolina Administrative Code › Title 21 - OCCUPATIONAL LICENSING BOARDS AND COMMISSIONS › Chapter 16 - DENTAL EXAMINERS › Subchapter B - LICENSURE DENTISTS › Section .1100 - REINSTATEMENT › Section 16B .1101 - APPLICATION FOR REINSTATEMENT AND PROOF OF COMPETENCY

Current through Register Vol. 39, No. 2, July 15, 2024
(a)
				  Any person desiring to practice dentistry in North Carolina whose North
				  Carolina dental license has been revoked, suspended, retired, or expired shall
				  submit to the Board an application for reinstatement. All applications for
				  reinstatement of a dental license shall be submitted on forms furnished by the
				  Board at www.ncdentalboard.org and shall include:
(1) original dental license number and date
				  of issuance;
(2) full
				  name;
(3) street address as of the
				  date of the application;
(4)
				  telephone number;
(5) email
				  address;
(6) citizenship or
				  immigration status, with verifying documentation;
(7) a statement disclosing and explaining the
				  nature, facts, and disposition of any matter where the applicant has ever:
(A) been summoned to court or before a
				  magistrate for the violation of any law or ordinance or for the commission of
				  any felony or misdemeanor;
(B) been
				  arrested for the violation of any law or ordinance or for the commission of any
				  felony or misdemeanor;
(C) been
				  taken into custody for the violation of any law or ordinance or for the
				  commission of any felony or misdemeanor;
(D) been indicted for the violation of any
				  law or ordinance or for the commission of any felony or misdemeanor;
(E) been convicted or tried for the violation
				  of any law or ordinance or for the commission of any felony or
				  misdemeanor;
(F) been charged with
				  the violation of any law or ordinance or for the commission of any felony or
				  misdemeanor; or
(G) pleaded guilty
				  to the violation of any law or ordinance or for the commission of any felony or
				  misdemeanor;
(8) whether
				  the applicant is under investigation as of the date of the application or has
				  ever been investigated by the Board or any other licensing board;
(9) whether the applicant has ever had a
				  civil lawsuit related to the practice of dentistry settled;
(10) all dental licenses from other
				  jurisdictions ever held by the applicant, including dates of
				  licensure;
(11) a statement
				  disclosing all the applicant's dental practices from dental school graduation
				  to the date of the application, including:
(A)
				  the dates during which the applicant was engaged in practice as a
				  dentist;
(B) the addresses of the
				  offices or places at which the applicant was employed or practicing, and the
				  names and addresses of all employers, partners, associates, or persons sharing
				  office space;
(C) whether the
				  applicant was practicing general dentistry or a specialty; and
(D) the reason for the termination of each
				  employment or period of private practice;
(12) a statement disclosing and explaining
				  any current condition or impairment, including substance abuse, alcohol abuse,
				  or a mental, emotional, or nervous disorder or condition, that in any way
				  affects the ability to practice dentistry. For purposes of this Rule, "current"
				  means recently enough that the condition or impairment may affect the
				  applicant's ability to function as a dentist as set out in
				  G.S.
				  90-41(a)(2) and (7). If the
				  applicant contends that the condition or impairment is reduced or ameliorated
				  because the applicant is receiving ongoing treatment or participating in a
				  monitoring or support program, the applicant may provide information regarding
				  the treatment or program, and may include any verification demonstrating that
				  the applicant has complied with all provisions and terms of any drug treatment
				  program, or impaired dentists or other impaired professionals
				  program;
(13) two letters of
				  character reference from non-family members;
(14) a copy of a National Practitioner Data
				  Bank report concerning the applicant that was obtained within six months prior
				  to the date the report is submitted to the Board;
(15) documentation of the applicant's
				  completion of continuing education courses, as set out in
				  21 NCAC
				  16R .0200, in amounts equal to the number of
				  hours required for renewal of a dental license; and
(16) a copy of an unexpired CPR
				  certificate.