Three-Year Limited Dentistry/Dental Hygiene License and Extension
Introduction | General Requirements | Limitations of the Three-Year Limited Dentistry/Dental Hygiene License and Extension | Federal Dental Health Shortage Areas | Application Forms for Three-Year Limited License | Limited License Extension | Fees | Partial Refunds
The three year limited license in dentistry/dental hygiene is available to qualified individuals who meet all requirements for licensure as a dentist or dental hygienist except for the citizenship/permanent residence requirement.
The Board of Regents may grant a three-year limited dentistry or dental hygiene license by granting a limited waiver of the citizenship/permanent residence requirements if the applicant agrees to provide services in a Federal Dental Health Professional Shortage Area of New York State.
All applicants must submit the required forms and fees for the three-year limited dentistry/dental hygiene licensure and an application, separate fee of $377 for dentistry and $128 for dental hygiene, and all required forms and documentation for regular dentistry/dental hygiene licensure in New York State. Application forms and information about the requirements for licensure in Dentistry or Dental Hygiene are available on this site.
Dentists or dental hygienists who obtain a three-year limited dentistry/dental hygiene license must agree to limit their practice to a shortage area of New York State. You are required to sign and have notarized an Affidavit of Agreement with the New York State Department of Health in which you formally agree to practice only in a specified shortage area. The affidavit must be amended with the Department of Health if the practice location or situation changes. The limited license is valid only for a three-year period; however, you may apply for an extension of six years.
Federal Dental Health Professional Shortage Areas (DHPSAs) are designated by the United States Department of Health and Human Services.
Detailed information on Dental Health Professional Shortage Areas may be found in The Federal Register. Since many of these DHPSAs (particularly those located in urban areas) are identified by census tracts, it is important to know the census tract of the practice site. Both The Federal Register and information on census tracts are commonly available at local libraries. Information on DHPSAs and census tracts is also available on the web at: www.ffiec.gov (select Geocoding mapping system) and http://hpsafind.hrsa.gov/HPSASearch.aspx .
Write the New York State Department of Health for information about the eligibility of specific practice locations. Include the name, address and profession of the applicant seeking the information and the name(s) and full address(es) of no more than five practice location(s).
New York State Department of Health
Division of Health Facility Planning
Corning Tower, Room 1084
Empire State Plaza
Albany, NY 12237
To apply for licensure you must submit the following forms, along with the appropriate fees, to the New York State Education Department's Office of the Professions at the address listed on the forms:
- the Form 1LL Application for a Three-Year Limited License and Extension ( 37 KB).
- the Application for Licensure and First Registration (Form 1) and all other required forms for New York State licensure as a dentist or dental hygienist.
- In addition, you must submit the Affidavit of Agreement ( 25 KB) to the NYS Department of Health, Division of Health Facility Planning, Corning Tower, Room 1084, Empire State Plaza, Albany, NY 12237.
It is your responsibility to follow up with anyone you have requested to send application processing materials to the Office of the Professions.
An extension of the three-year limited license may be granted to a dentist or dental hygienist actively pursuing permanent resident status. The limitations of the three-year limited license remain in effect during the extension. The extension may be issued for six years.
To apply for the limited license extension you must submit the following materials along with the appropriate fees to the New York State Education Department's Office of the Professions:
- the Application for a Limited License (Form 1LL 37 KB). Mark the box to indicate you are applying for an extension.
- evidence that you are actively pursuing permanent residency status.
NOTE: A new Affidavit of Agreement is not needed unless you are changing your previously approved service area.
The application fee for the three-year limited license in dentistry is $377 and in dental hygiene is $128. In addition, you must submit the application (Form 1) and applicable fees for regular licensure.
The application and registration fee for an extension of a limited license is $377 for dentists and $128 for dental hygienists.
Fees are subject to change. The fee due is the one in law when your application is received (unless fees are increased retroactively). You will be billed for the difference if fees have been increased.
- Do not send cash.
- Make your personal check or money order payable to the New York State Education Department.* Your cancelled check is your receipt.
- Mail your application and fee to:
NYS Education Department
Office of the Professions
P.O. Box 22063
Albany, NY 12201.
*NOTE: Payment submitted from outside the United States should be made by check or draft on a United States bank and in United States currency; payments submitted in any other form will not be accepted and will be returned.
Individuals who withdraw their licensure application may be entitled to a partial refund.
- For the procedure to withdraw your application, contact the Dentistry Unit at firstname.lastname@example.org or by calling 518-474-3817 ext. 270 or by fax at 518-402-5354.
- The State Education Department is not responsible for any fees paid to an outside testing or credentials verification agency.
If you withdraw your application, obtain a refund, and then decide to seek New York State licensure at a later date, you will be considered a new applicant, and you will be required to pay the licensure and registration fees and meet the licensure requirements in place at the time you reapply.