Wisconsin Department of Safety and Professional Services
Health & Business Renewal Application
Application Status Query
Instructions:
Please allow one hour after receipt of your status update email for the updates to be reflected in the online checklist.
Please verify the checklist information below, including your address. If your address has changed, please
e-mail
your application number, name, profession, along with your old and new address. The Credentialing department posts status information following receipt and review of application materials.
As of
:
04/30/2009
Application#
:
331424
Name
:
SABEL, NICHOLAS JAMES
Profession
:
Dentistry
Address
:
South Milwaukee, WI
Application Status
:
(Permanent license issued)
Requirements Not Met:
Description
Status
Comments (Please note, not all requirements will include comments)
Requirements Met:
Description
Status
Comments (Please note, not all requirements will include comments)
Wisconsin Statutes & Rules Examination
Met
PASSED
PAGE 1
Met
Applicable blanks completed
Met
Application Fee
Met
$
PAGE 2
Met
Applicable blanks completed
Met
All activities and practice accounted for from the date of graduation to the present. Provide employers name, location (city&state), dates (month&year), # of hours worked per week, job title & duties
Met
PAGE 3
Met
All questions answered and relevant copies attached
Met
Affidavit of applicant, signed
Met
National Practitioner Data Bank Report/Self-query response
Met
Certificate of Professional Education (Form #1463) (including signature and school seal)
Met
Regional Dental Testing Service Score Card(s) (Original(s) pass & fail)
Met
CRDTS
Passed Parts II, III and V 8/09/2008.
Passed part I, 3/31/09
Failed Part IV 8/09/2008.
Passed Part IV 4/17/09
National Board Score Card(s) (Original(s) pass & fail)
Met
Social Security Number
Met
AED/CPR Certification
Met
EXPIRES: 3/2011
Certification of Legal Status Completed
Met
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