Application Overview

 License Applications

An individual may apply for a license to practice as a dentist by completing an application.  Each application contains a checklist of required documents along with a cover page explaining the application process.  After reviewing the application, please contact our office if you have any questions or need assistance. 

The application for new license is for a dentist that has passed a patient based clinical competency dental examination within five years preceding the date of application. The examination must meet criteria outlined in ARSD 20:43:03:02 to be accepted for licensure. Verification from the testing agency that the exam meets all requirements may be requested.

Dentist-Application for New License

The application by credential verification is for individuals that are currently licensed to practice as a dentist in another state and have completed a minimum of three thousand clinical practice hours within the five years preceding the date of application.  If an individual is applying via credential verification, the Board accepts the following patient based clinical competency dental examinations: CRDTS, WREB, CDCA, CITA, or SRTA. 

Dentist - Application by Credential Verification

Individuals applying for a license to practice as a dentist are required to complete a criminal background check.  To obtain a criminal background check information packet, including instructions and fingerprint cards, please contact our office.  You must use the fingerprint cards that you receive from our office, as specific agency data is pre-printed on them.  Other fingerprint cards will not be accepted.    

Request a CBC Packet

Anesthesia & Sedation

A dentist that would like to administer nitrous oxide sedation and analgesia must hold a nitrous oxide sedation and analgesia permit. 

To apply for a nitrous oxide sedation and analgesia permit, a dentist must complete the application.

Dentist - Application to Administer Nitrous Oxide

Pursuant to § 20:43:09:09, all dentists must notify the board within 72 hours after any death or any incident that results in temporary or permanent physical or mental injury requiring medical treatment of the dentist's patient during, or as a result of, the administration of general anesthesia, and deep sedation, moderate sedation, or nitrous oxide sedation and analgesia. It is not necessary to report incidents such as nausea, a single episode of emesis, or a mild allergic reaction. A complete written report must be submitted to the Board within 30 days of the incident.

Adverse Condition Report Form

A dentist that would like to utilize the services of a licensed anesthesia provider must hold a host permit.

For an overview of the permit application and inspection process, please download this presentation.

APPLICATION - To apply for a host permit, a Dentist must submit a completed application and pass a facility inspection.  To initiate the facility inspection, a Dentist must complete Form T1: Practitioner Anesthesia Inspection Checklist and submit the Checklist to the Board office.  The Dentist will then be assigned an Inspector.

Dentist - Host Permit Application  

Form T1: Practitioner Anesthesia Inspection Checklist- Facility Only  

FACILITY INSPECTION – A facility inspection includes:

Dentist + Inspector + Licensed Anesthesia Provider: The Inspector and the Dentist schedule a time to complete the facility inspection.  The facility inspection must include participation by both the Dentist and a Licensed Anesthesia Provider.  Utilization of video conferencing to conduct a facility inspection is allowed if the Dentist is joining an established practice that has previously undergone a full inspection (i.e., a full inspection has been conducted in that facility in the prior 5 years). During the facility inspection, the Inspector completes Form T2: Facility Inspection/Temporary Permit Office Anesthesia Inspection Results Form.  The Inspector submits the completed form to the Board office after the facility inspection. 

Form T2: Facility Inspection/ Temporary Permit Office Anesthesia Inspection Results Form

TEMPORARY PERMIT – Following passage of a facility inspection, a temporary host permit may be issued for up to twelve months.  During the term of the temporary permit, the Dentist must pass a full inspection to obtain a host permit. 

FULL INSPECTION - A full inspection required to obtain and maintain a host permit includes three steps:

  1. Dentist: The Dentist completes Form 1: Practitioner Anesthesia Inspection Checklist and mails the Checklist and three redacted anesthesia records to the Board office. 

Form 1: Practitioner Anesthesia Inspection Checklist- Full Inspection

  1. Inspector: An assigned Inspector conducts a review of the Checklist and anesthesia records and completes Form 2: Office Anesthesia Inspection Results Full Inspection (Checklist and Records Review).  The Inspector submits this completed form to the Board office after the review.

Form 2: Office  Anesthesia Inspection Results- Full Inspection

  1. Dentist + Inspector + Team: An Inspector and Dentist schedule a time to complete the Emergency Response Review portion of the full inspection.  The Emergency Response Review can be conducted via video conferencing and does not include a patient procedure.  This review must include participation by the Dentist, a Licensed Anesthesia Provider, and the entire team that will assist and respond to an emergency.  During the review, the Inspector completes Form 3: Office Anesthesia Inspection Results Full Inspection (Emergency Response Review).  The Inspector submits this completed form to the Board office after the review. 

Form 3: Office  Anesthesia Inspection Results- Full Inspection 

PERMIT Upon passage of the full office anesthesia inspection, a host permit can be issued. To maintain a host permit, a Dentist must meet all requirements outlined regulations including but not limited to:  

  • During each five-year licensure cycle: Pass a full office anesthesia inspection (20:43:09:11, 20:43:09:12) and complete 25 hours of continuing education in anesthesia related topics (20:43:03:07).
  • Annually:  Document completion of team training (ARSD 20:43:03:07) and complete the requisite cases or continuing education (ARSD 20:43:09:08). 

A Dentist who holds a host permit and builds a new facility should complete a facility inspection.  Please contact the Board office before construction is complete, so an inspection can be scheduled upon completion of construction.  

All courses that have been approved for a host permit are listed in the application for a host permit. To request approval of a course that is not listed on this application, but meets the requirements in ARSD 20:43:09, please complete the course approval request form.

Host Permit Course Approval Request Form  

Pursuant to § 20:43:09:09, all dentists must notify the board within 72 hours after any death or any incident that results in temporary or permanent physical or mental injury requiring medical treatment of the dentist's patient during, or as a result of, the administration of general anesthesia, and deep sedation, moderate sedation, or nitrous oxide sedation and analgesia. It is not necessary to report incidents such as nausea, a single episode of emesis, or a mild allergic reaction. A complete written report must be submitted to the Board within 30 days of the incident.

Adverse Condition Report Form

A dentist that would like to administer moderate sedation must hold a moderate sedation permit. 

For an overview of the permit application and inspection process, please download this presentation.

APPLICATION - To apply for a moderate sedation permit, a Dentist must submit a completed application and pass a facility inspection.  To initiate the facility inspection, a Dentist must complete Form T1: Practitioner Anesthesia Inspection Checklist and submit the Checklist to the Board office.  The Dentist will then be assigned an Inspector.

Dentist - Application to Administer Moderate Sedation  

Form T1: Practitioner Anesthesia Inspection Checklist- Facility Only  

FACILITY INSPECTION – A facility inspection includes:

Dentist + Inspector: The Inspector and the Dentist schedule a time to complete the facility inspection. Utilization of video conferencing to conduct a facility inspection is allowed if the Dentist is joining an established practice that has previously undergone a full inspection (i.e., a full inspection has been conducted in that facility in the prior 5 years). During the facility inspection, the Inspector completes Form T2: Facility Inspection/Temporary Permit Office Anesthesia Inspection Results Form.  The Inspector submits the completed form to the Board office after the facility inspection. 

Form T2: Facility Inspection/ Temporary Permit Office Anesthesia Inspection Results Form

TEMPORARY PERMIT – Following passage of a facility inspection, a temporary moderate sedation permit may be issued for up to twelve months.  During the term of the temporary permit, the Dentist must pass a full inspection to obtain a moderate sedation permit. 

FULL INSPECTION - A full inspection required to obtain and maintain a moderate sedation permit includes three steps:

  1. Dentist: The Dentist completes Form 1: Practitioner Anesthesia Inspection Checklist and mails the Checklist and three redacted anesthesia records to the Board office. 

Form 1: Practitioner Anesthesia Inspection Checklist- Full Inspection

  1. Inspector: An assigned Inspector conducts a review of the Checklist and anesthesia records and completes Form 2: Office Anesthesia Inspection Results Full Inspection (Checklist and Records Review).  The Inspector submits this completed form to the Board office after the review.

Form 2: Office  Anesthesia Inspection Results- Full Inspection

  1. Dentist + Inspector + Team: An Inspector and Dentist schedule a time to complete the Emergency Response Review portion of the full inspection.  The Emergency Response Review can be conducted via video conferencing and does not include a patient procedure.  This review must include participation by the Dentist and the entire team that will assist and respond to an emergency.  During the review, the Inspector completes Form 3: Office Anesthesia Inspection Results Full Inspection (Emergency Response Review).  The Inspector submits this completed form to the Board office after the review. 

Form 3: Office  Anesthesia Inspection Results- Full Inspection 

PERMIT - Upon passage of the full office anesthesia inspection, a moderate sedation permit can be issued. To maintain a moderate sedation permit, a Dentist must meet all requirements outlined regulations including but not limited to:  

  • During each five-year licensure cycle: Pass a full office anesthesia inspection (20:43:09:11, 20:43:09:12) and complete 25 hours of continuing education in anesthesia related topics (20:43:03:07).
  • Annually:  Document completion of team training (ARSD 20:43:03:07) and complete the requisite cases or continuing education (ARSD 20:43:09:08). 

A Dentist who holds a moderate sedation permit and builds a new facility should complete a facility inspection.  Please contact the Board office before construction is complete, so an inspection can be scheduled upon completion of construction.

All courses that have been approved for a moderate sedation permit are listed in the application to administer moderate sedation.  To request approval of a course that is not listed on this application, but meets the requirements in ARSD 20:43:09, please complete the course approval request form. 

Moderate Sedation Course Approval Request Form

Pursuant to § 20:43:09:09, all dentists must notify the board within 72 hours after any death or any incident that results in temporary or permanent physical or mental injury requiring medical treatment of the dentist’s patient during, or as a result of, the administration of general anesthesia, and deep sedation,   moderate sedation, or nitrous oxide sedation and analgesia. It is not necessary to report incidents such as nausea, a single episode of emesis, or a mild allergic reaction. A complete written report must be submitted to the Board within 30 days of the incident.

Adverse Condition Report Form

A dentist that would like to administer general anesthesia or deep sedation must hold a general anesthesia and deep sedation permit. 

For an overview of the permit application and inspection process, please download this presentation.

APPLICATION - To apply for a general anesthesia and deep sedation permit, a Dentist must submit a completed application and pass a facility inspection.  To initiate the facility inspection, a Dentist must complete Form T1: Practitioner Anesthesia Inspection Checklist and submit the Checklist to the Board office.  The Dentist will then be assigned an Inspector.

Dentist - Application to Administer General Anesthesia and Deep Sedation  

Form T1: Practitioner Anesthesia Inspection Checklist- Facility Only  

FACILITY INSPECTION – A facility inspection includes:

Dentist + Inspector: The Inspector and the Dentist schedule a time to complete the facility inspection. Utilization of video conferencing to conduct a facility inspection is allowed if the Dentist is joining an established practice that has previously undergone a full inspection (i.e., a full inspection has been conducted in that facility in the prior 5 years). During the facility inspection, the Inspector completes Form T2: Facility Inspection/Temporary Permit Office Anesthesia Inspection Results Form.  The Inspector submits the completed form to the Board office after the facility inspection. 

Form T2: Facility Inspection/ Temporary Permit Office Anesthesia Inspection Results Form

TEMPORARY PERMIT – Following passage of a facility inspection, a temporary general anesthesia and deep sedation permit may be issued for up to twelve months.  During the term of the temporary permit, the Dentist must pass a full inspection to obtain a general anesthesia and deep sedation permit. 

FULL INSPECTION - A full inspection required to obtain and maintain a general anesthesia and deep sedation permit includes three steps:

  1. Dentist: The Dentist completes Form 1: Practitioner Anesthesia Inspection Checklist and mails the Checklist and three redacted anesthesia records to the Board office. 

Form 1: Practitioner Anesthesia Inspection Checklist- Full Inspection

  1. Inspector: An assigned Inspector conducts a review of the Checklist and anesthesia records and completes Form 2: Office Anesthesia Inspection Results Full Inspection (Checklist and Records Review).  The Inspector submits this completed form to the Board office after the review.

Form 2: Office  Anesthesia Inspection Results- Full Inspection

  1. Dentist + Inspector + Team: An Inspector and Dentist schedule a time to complete the Emergency Response Review portion of the full inspection.  The Emergency Response Review can be conducted via video conferencing and does not include a patient procedure.  This review must include participation by the Dentist and the entire team that will assist and respond to an emergency.  During the review, the Inspector completes Form 3: Office Anesthesia Inspection Results Full Inspection (Emergency Response Review).  The Inspector submits this completed form to the Board office after the review. 

Form 3: Office  Anesthesia Inspection Results- Full Inspection 

PERMIT Upon passage of the full office anesthesia inspection, a general anesthesia and deep sedation permit can be issued. To maintain a general anesthesia and deep sedation permit, a Dentist must meet all requirements outlined regulations including but not limited to:  

  • During each five-year licensure cycle: Pass a full office anesthesia inspection (20:43:09:11, 20:43:09:12) and complete 25 hours of continuing education in anesthesia related topics (20:43:03:07).
  • Annually:  Document completion of team training (ARSD 20:43:03:07) and complete the requisite cases or continuing education (ARSD 20:43:09:08). 

A Dentist who holds a general anesthesia and deep sedation permit and builds a new facility should complete a facility inspection.  Please contact the Board office before construction is complete, so an inspection can be scheduled upon completion of construction.  

Pursuant to § 20:43:09:09, all dentists must notify the board within 72 hours after any death or any incident that results in temporary or permanent physical or mental injury requiring medical treatment of the dentist’s patient during, or as a result of, the administration of general anesthesia, and deep sedation,   moderate sedation, or nitrous oxide sedation and analgesia. It is not necessary to report incidents such as nausea, a single episode of emesis, or a mild allergic reaction. A complete written report must be submitted to the Board within 30 days of the incident.   

Adverse Condition Report Form

Dentists who dispense, administer, or prescribe controlled substances in South Dakota must have a South Dakota Controlled Substance Registration and federal Drug Enforcement Administration Registration.  Dentists that hold a South Dakota Controlled Substance Registration must also register with the South Dakota PDMP .

Dentists that hold a South Dakota Controlled Substance Registration must register with the South Dakota PDMP .

Anesthesia inspectors please log into your account to view the anesthesia inspections that have been assigned to you. 

Account Login

FACILITY ONLY INSPECTION - Once a completed application is received and approved, the applicant must pass a temporary permit – facility only inspection before a temporary sedation or anesthesia permit will be issued.  To initiate the facility inspection, a Dentist must complete the Practitioner Anesthesia Inspection Checklist and submit the Checklist to the Board office.  The Dentist will then be assigned an Inspector.  The Inspector and the Dentist schedule a time to complete the facility inspection. Utilization of video conferencing to conduct a facility inspection is allowed if the Dentist is joining an established practice that has previously undergone a full inspection (i.e., a full inspection has been conducted in that facility in the prior 5 years). During the facility inspection, the Inspector completes Form T2: Facility Inspection/Temporary Permit Office Anesthesia Inspection Results Form.  The Inspector submits the completed form to the Board office after the facility inspection. 

Form T2: Facility Inspection/ Temporary Permit Office Anesthesia Inspection Results Form

FULL INSPECTION - A full inspection required to obtain and maintain a sedation permit includes three steps:

  1. Dentist: The Dentist completes Form 1: Practitioner Anesthesia Inspection Checklist and mails the Checklist and three redacted anesthesia records to the Board office. 

Form 1:Practitioner Anesthesia Inspection Checklist- Full Inspection

  1. Inspector: An assigned Inspector conducts a review of the Checklist and anesthesia records and completes Form 2: Office Anesthesia Inspection Results Full Inspection (Checklist and Records Review).  The Inspector submits this completed form to the Board office after the review.

Form 2: Office  Anesthesia Inspection Results- Full Inspection

  1. Dentist + Inspector + Team: An Inspector and Dentist schedule a time to complete the Emergency Response Review portion of the full inspection.  The Emergency Response Review can be conducted via video conferencing and does not include a patient procedure.  This review must include participation by the Dentist and the entire team that will assist and respond to an emergency.  During the review, the Inspector completes Form 3: Office Anesthesia Inspection Results Full Inspection (Emergency Response Review).  The Inspector submits this completed form to the Board office after the review. 

Form 3: Office  Anesthesia Inspection Results- Full Inspection 

Upon completion of an anesthesia inspection in which travel is required, please complete the anesthesia inspector travel voucher and submit to our office.  This form must be received within 20 business days following completion of the inspection.  This form can be emailed to our office to expedite processing. If the inspection was completed via video conferencing, and no travel was required, you do not need to submit a voucher to receive payment for the inspection fee.          

Anesthesia Inspector Travel Voucher  

The ACC is a peer review committee appointed by the Board.  The ACC may perform the following duties at the request of the board:

(1)  Review permit applications and approve an application if the requirements of the chapter have been met;
(2)  Review educational courses or residency programs and make recommendations to the board;
(3)  Review inspector candidates and make recommendations to the board; and
(4)  Other duties as delegated by the board or board president.

Additional information about the ACC can be found at ARSD 20:43:09:16.  If you are interested in serving on the ACC in any open position noted in the link below, please submit an application by May 1st.

ACC Application

ACC Terms and Appointments

Volunteer Registration

A dentist may apply for a Temporary Volunteer Registration that authorizes the dentist to practice for up to one week in a volunteer capacity. Please submit a complete application and all supporting documents at least twenty business days prior to the dates of service. 

Temporary Volunteer Registration Application

Dental Entities

One or more dentists licensed pursuant to chapter 36-6A may associate to form a corporation, limited liability company, limited partnership, limited liability partnership, or limited liability limited partnership, registered to do business in this state, to own, operate, and maintain an establishment for the study, diagnosis, and treatment of dental ailments and injuries, to promote dental and scientific research and knowledge, and for any other purpose incident or necessary thereto. 

To register a corporation, limited liability company, limited partnership, limited liability partnership, or limited liability limited partnership, or qualified entity please complete the dental entity application for registration. 

Dental Entity Application for Registration

Please complete the Dental Entity Change in Ownership or Management form for any proposed admission, removal, or change of a director, manager, member, partner, or shareholder of a dental entity registered with the Board.  This form must be submitted at least thirty days prior to the proposed action. 

Dental Entity Change in Ownership or Management

Application Status

You may check the status of your application at any time by clicking on the Application Status link below and logging in with the indicated personal information. If any required documentation is missing or incomplete it will be indicated in the status and/or comment spaces. This information is updated as documents are received, so please check this link prior to calling the office to check on the status of your application. Once your application is complete and processed the link below will no longer work and will return a message of "No record was found with those credentials".

If you have any questions, please contact our office.

Application Status

Page Updated: 8/30/2022 8:12:10 AM