1. Valid dental license with expiration date
2. Proof of liability insurance
3. Documentation of 15 hours of recognized (ADA CERP or AGD PACE) continuing education credits in dental sleep medicine through any provider earned within the last 2 years
4. Administrative fee of $100.00
A link for paying the administrative fee will be emailed to you separately after you submit the application form including dental license, proof of liability, and CE verification.
For CE hours, please submit the CE verification letter or certificate (CE transcripts are not accepted) and documentation of the course outline or detailed course objectives.
If you are filling out this form for the first time, please click the New Submission button on the left .
If you are returning to edit or complete a previous submission, please fill out the email address and access code you set up previously and click Edit Submission.