Dental Expired License ( 1 -3 Years) Activation Application - doh wa 2026

1. Click ‘Get Form’ to open the Dental Expired License Activation Application in the editor.
2. Begin by filling out the Demographic Information section. Enter your Social Security Number, legal name, birth date, and place of birth. Ensure accuracy as discrepancies may delay processing.
3. Provide your current address and contact information, including phone numbers and email. This will be your official record with the Department of Health.
4. In the Previous Credentialing section, list all credentials held since your last active credential in Washington State. Attach additional pages if necessary.
5. Detail your Professional Experience chronologically, starting from the most recent position. Include start and end dates for each role.
6. Complete the required attestations regarding AIDS education, disciplinary actions, and continuing education. Initial and date each attestation.
7. Finally, sign and date the Applicant’s Attestation to confirm that all information is accurate before submitting your application.

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