EFTA00532566.pdf

From: VIBOARDS LICENSURE To: Andrew Buckle Kurt Buska Gigi Denise Colbert jobyteach Caines L. Fabio" Griffith Anna G James Ste hen Mackler Mariam Habib Ja Last , Michael Enloe , Whitney Gra , Alan Hinkle Daniel Kenses Shawn Lottier ,Nas Mazuji Cora Marsaw PEDIATRICDENTIST "Stanford , Horace Jennifer Alanzo Moolenaar Talia Moses , Kistama Naidu comcast.net Donald Pomeranz Louis Ross , Rome Sabnani "E. Robert Wardius" , Stuart Lori Wilson "Dr. Jaya" , Dale Manuel , anita brown , Kat Bednar Candace Kwakye Bryan Mitchell Soleil Roberts 'fade de Marsche Subject: VI Dental License Renewal 2016-2018 Date: Wed, 03 Aug 2016 01:19:33 +0000 Attachments: ATTACHMENT_l_DDS.pdf; ATTACHMENT_2_PCO_Survey_Letter.pdf; Attachment_2A_PCO_DENTAL.pdf; ATTACHMENT_3_VIIRB.pdf MEMORANDUM: DATE: August 2, 2016 TO: All VI Licensed Dentists FROM: Deborah Richardson-Peter, MPA Director, Professional Licensure & Health Planning EFTA00532566 RE: VI Dentist License Renewal 2016-2018 The following documents are required to renew your 2014-2016 VI Dentist License: CHECK LIST I. Completed renewal application form (typed -fellable form attached)Attachment 1; 2. Primary Care Office Survey (PCO), Attachment 2, 2A 3. Copy of required liability coverage; "Government of the VI Certificate of Insurance"; or if you are not participating in the Government's liability insurance program you must submit approval of your liability coverage from the Office of Risk Management (Please contact Mrs. Trisha James, Director of Risk Management to ensure timely processing before deadline Telephon Email: 4. 1RB Original Tax Clearance Letter, Please see IRB instructions Attachment 3; 5. Copy of current DEA registration; 6. Copies of minimum 30 continuing education credits dated October 1, 2014 to present; and 7. $400.00 Renewal fee (Check or money order made payable to "Government of the Virgin Islands"). Complete, print, sign and mail renewal application form, PCO survey, payment, DEA registration, continuing education credits, and original tax clearance letter to: Office of Professional Licensure and I I ealth Planning VI Department of Health 3500 Estate Richmond Christiansted, VI 00820-4370 ***ALL INCOMPLETE APPLICATIONS WILL BE RETURNED*** It is your responsibility to maintain a license to practice in the territory; therefore you are reminded that it is illegal to practice without a current license. All documents MUST be received by the Office of Professional Licensure and Health Planning no later than September 1, 2016 to ensure timely renewal of your license. Documents submitted after September 1, 2016 are NOT guaranteed for October 1, 2016 issuance/renewal. All renewal applications received on/after October I, 2016 will be assessed a late fee. If you wish to place your license on "Inactive" status, you must do so in writing to the board prior to your license expiration on September 30, 2016. Please contact the Office Health Planning if you have any questions or need further assistance by calling Deborah Richardson- Peter, MPA Director. Professional Licensure Health Planning EFTA00532567