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Dental Hygiene License Application Packet - Washington … - california dental hygienist license verification


Dental Hygiene License Application Packet - Washington …-california dental hygienist license verification

Dental Hygiene License Application Packet
Contents:
1. 645-135.....Contents List/SSN Information/Mailing Information............................ 1 page
2. 645-145.....Application Instructions Checklist.......................................................4 pages
3. 645-137.....License Requirements...................................................................... 2 pages
4. 645-090.....Dental Hygiene License Application...................................................5 pages
5. 645-117......Expanded Functions Education Information....................................... 1 page
6. 645-089.....Education Verification.......................................................................... 1 page
7. DANB.........Dental Hygiene Law Examination Fact Sheet, Law Exam Application,
Application Agreement, and Special Accommodations Form..........10 pages
8. RCW/WAC and Online Website Links..................................................................... 1 page
Important Social Security Number Information:
If you have a Social Security Number, the law requires you to disclose it on your
application for a professional or occupational license. 42 U.S.C. ? 666(a)(13); RCW
26.23.150. It will be used under the state's child support enforcement program to locate
individuals for purposes of establishing paternity and establishing, modifying, and enforcing
support obligations. You are not required to have or obtain a Social Security Number to
apply for or obtain a license from the Department of Health. If you do not have a Social
Security Number, you are still eligible to apply for and obtain a credential if you meet the
requirements. Please see the Declaration of No Social Security Number Form. Please call
the Customer Service Center at 360-236-4700 if you have questions.
In order to process your request:
Mail your application with initial
documentation and your check Send other documents not sent
or money order payable to: with initial application to:
Department of Health Dental Hygiene Credentialing
P.O. Box 1099 P.O. Box 47877
Olympia, WA 98507-1099 Olympia, WA 98504-7877
Contact us:
360-236-4700
To request this document in another format, call 1-800-525-0127. Deaf or hard of hearing
customers, please call 711 (Washington Relay) or email civil.rights@doh.wa.gov.
DOH 645-135 June 2022
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Application Instructions Checklist
You should use this application to obtain a dental hygiene license if you have completed
an approved dental hygiene education program. The program must be accredited by
the American Dental Association Commission on Dental Accreditation (CODA). The
program must have included the following curriculum:
a. Didactic and clinical competency in the administration of injections of local
anesthetic, which includes infiltration: ASA, MSA, Nasopalatine, greater palatine.
Block: Long buccal, mental, inferior alveolar and PSA.
b. Didactic and clinical competency in the administration of nitrous oxide analgesia.
c. Didactic and clinical competency in the placement of restorations into cavities
prepared by a dentist.
d. Didactic and clinical competency in the carving, contouring and adjusting contacts
and occlusions of restorations.
If your program did not include the above curriculum:
? You may complete a Washington State approved expanded function education
program(s) to meet this requirement. A list of approved expanded function
education programs is enclosed in this application.
? You may qualify for the initial limited license. There is a separate initial limited
license application. See the requirements for an initial limited license on our
website.
Important background check Information: Washington State law authorizes the
Department of Health to obtain fingerprint-based background checks for licensing
purposes. This check may be through the Washington State Patrol and the Federal
Bureau of Investigation (FBI). This may be required if you have lived in another state or
if you have a criminal record in Washington State. This would be at your own expense.
All information should be printed clearly in ink. It is your responsibility to submit the
required forms.
FF Application Fee. This fee is non-refundable. You can check the online fee page for
current fees.
FF Check if either apply:
Request for Military Training and Experience Evaluation
Spouse or Registered Domestic Partner of Military Personnel
FF 1. Demographic Information:
Social Security Number: You must list your social security number on your
application. You are not required to have or obtain a Social Security Number
to apply for or obtain a license from the Department of Health. Please see the
Declaration of No Social Security Number Form. Please call the Customer Service
Center at 360-236-4700 if you do not have one.
National Provider Identifier Number (NPI): The National Provider Identifier (NPI)
is a standard unique identifier for health care professionals available from the
DOH 645-146 June 2022 Page 1 of 4

What are the education requirements to be a dental hygienist?Important Facts About Dental HygienistsEntry-Level Education Requirements. The minimum education requirement to work as a dental hygienist is an associate's degree or certificate in dental hygiene.Advanced Education Options. ...Licensure Requirements. ...