Application Forms
The following forms may be printed and attached with your application for license, permit, registration or qualification. If the application will be completed online, you may scan/photograph and attach the completed forms prior to submitting the application. If you have already submitted an application, you may email or fax the completed forms.
Please note: The original copy of the Certification of Education should be forwarded to the Board office to complete your application.
National Practitioner Data Bank (NPDB)
Applicants for a dental license, dental hygiene license or faculty permit must submit the results of a self-query of the National Practitioner Data Bank. To submit a request to the NPDB for a self query, please visit the NPDB's website. Upon receipt of the results, please email or fax a copy of the results to the Board office. You are not required to forward an original copy of the results to the Board.
Dental Assistants |
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Dental Assistant Trainee | Signature of Applicant/Statement of Employer |
RDA/QDA Application Forms |
Affidavit of Employment (Required if training was completed as a dental assistant trainee.) Certification of Education (For graduates of an ADA-accredited dental assisting program.) |
XDA/QDA Radiography Qualification |
Certification of Dental Radiography Training |
Dental Hygienists |
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RDH License Application Forms |
Certification of License* |
Local Anesthesia Application Forms | |
Dentists |
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DDS License Application Forms |
Certification of License* |
Moderate Sedation or General Anesthesia Application Forms |
Certification of Moderate Sedation Training Verification of Postgraduate Residency Program (General Anesthesia) |
Faculty/Residents |
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The following forms need to be submitted with an application for faculty permit or resident license. The forms must be completed by the University of Iowa College of Dentistry or other ADA-accredited program in Iowa where the applicant is employed as a faculty member or enrolled as a resident. | |
Faculty Certification | Faculty Certification |
Resident Certification | Resident Certification |
Please submit the completed forms to:
Iowa Dental Board
400 SW 8th St. Suite D
Des Moines, IA 50309
Email: IDB@iowa.gov
Fax: 515-281-7969