A person who, in order to induce favorable action by the Arkansas State Board of Dental Examiners on any application for a license to practice dentistry or dental hygiene in the State of Arkansas, makes any statement to the board, whether orally or in writing, which is false and at the time known by the person to be false or who submits or files as his or her own any diploma or license belonging or issued to another person or who in any other manner misrepresents or conceals his or her true name or former place of residence commits a Class D felony.