Washington § 70.352.030 - Application for registration or renewal — Requirements — Fee.

(1) Each dental laboratory operating, doing business, or intending to operate or do business within this state must submit an application for registration of dental laboratory or renewal of registration of dental laboratory to the department on a form provided by the department accompanied with the registration or renewal fee required. The application must include:

(a) The name, mailing address, phone number, and email address of the dental laboratory;

(b) The physical address of the dental laboratory if different from the mailing address;

(c) The name, mailing address, phone number, and email address of the responsible person or the name and license number of the supervising dentist who is licensed under chapter 18.32 RCW;

(d) A statement that the dental laboratory meets the infectious control requirements under the occupational safety and health administration and the centers for disease control and prevention of the United States public health service;

(e) An acknowledgment by the responsible person or the supervising dentist that the laboratory will provide material disclosure to the prescribing dentist that contains the manufacturer and brand name or the United States food and drug administration registration number of all patient contact materials contained in the prescribed restoration in order that the dentist may include those numbers in the patient's record; and

(f) An acknowledgment by the responsible person or the supervising dentist who is licensed in this state that he or she will disclose to the prescribing dentist the point of origin of the manufacture of the prescribed restoration. If the restoration was partially or entirely manufactured by a third-party provider, the point of origin disclosure must identify the portion manufactured by a third-party provider and the city, state, and country of the provider.

(2) Each dental laboratory shall pay a registration fee annually as determined by the secretary as provided in RCW 43.70.250.