(a) An applicant seeking a temporary charitable dental license shall submit an application and any application fees required by the Arkansas State Board of Dental Examiners and:

1. (1) The name of the supervising dentist who is licensed in Arkansas;
2. (2) The dates and location where the applicant desires to practice within Arkansas;
3. (3) A copy of the applicant’s dental license from another jurisdiction;

4. (4)

   1. (A) A letter from the respective dental licensing entity in the home state of the applicant indicating that the applicant is in good standing.
   2. (B) As used in this section, “good standing” means that individual has an active license without a complaint, investigation, or action against him or her;
5. (5) A copy of the malpractice insurance policy covering the applicant or a certificate of insurance coverage from the underwriting insurer of the policy; and
6. (6) Other pertinent information as determined by the board.

(b) An applicant seeking a temporary charitable dental license issued by the board shall:

1. (1) Provide written authorization to the board to allow the Division of Arkansas State Police to release the results of state and federal criminal history background checks to the board as required under Arkansas Code § 17-82-801 et seq.; and
2. (2) Pay the fees associated with the criminal background checks.

(c)

1. (1) A dentist shall not practice in Arkansas under this section until the board issues a temporary charitable dental license.

2. (2) The board may renew a temporary charitable dental license in subsequent years if the dentist submits:

   1. (A) A renewal form;
   2. (B) A renewal fee determined by the board; and
   3. (C) Any other information as determined by the board.
3. (3) The practice of dentistry without compensation for no more than four (4) consecutive days per calendar year in the State of Arkansas by a dentist licensed in another state or the District of Columbia if the dentist has applied for and received a temporary license from the board.