Out of State Charitable Permit
Coming from out of state to participate in IndianaMOM? First of all, Thank You!
Secondly, the Indiana State Board of Dentistry requires all out of state dentists and hygienists to obtain a charitable dental permit no more than 60 days prior to the charitable event.
Download Out of State Application
Dentists and Hygienists coming from out of state to participate in IndianaMOM must apply for a Voluntary Charitable Permit no later than May 1, 2017.
- DOWNLOAD the application and review the included instructions.
- Proof of current malpractice coverage must be returned with the completed application.
- Include a cover letter explaining the reason for requesting the charitable permit (a sample is included with the download).
- Return the application, proof of malpractice coverage, and cover letter to the Indiana State Board of Dentistry no later than May 1, 2017.
Professional Licensing Agency
Attn: Indiana State Board Of Dentistry
402 W. Washington Street, Room W072
Indianapolis, Indiana 46204