Licensing Forms

Dentists

Change of Address
Name Change Request
Duplicate Renewal License
Verification of Licensure Request
Designation of Records
Board Scores
Wall License Replacement

Clinical Affidavit 2023

Hygienists

Change of Address
Name Change Request
Duplicate Renewal License
Verification of Licensure or Registration
Board Scores
Wall License Replacement

Dental Assistants

Change of Address
Name Change Request
Verification of Certificate or Registration
Duplicate Renewal License

Dental Laboratories

Change of Address
Change the Certified Dental Technician of Record
Duplicate Registration Certificate
Closure Notification

Mobile Facilities

Change of Address – 2021
Duplicate Registration Certificate