Name and Address Changes - Licensed Dentists

Every dentist is required to register his/ her place(s) of practice with the Board on a form prescribed by the Board. B&P §§ 1650, 1651 Every dentist licensed in this state must also notify the Board if he/she has no place of practice. Any dentist who changes his/her place of practice must register with the Board within one month after the change.

Address Change

In the event any licensee fails to notify the Board of a change of address within one month, the board may not renew his/her license until the penalty is paid. The penalty for late registration of change of place of practice is $50.00.

All places of practice must be registered with the Board. An additional office permit is required if a licensee has proprietary interest of any nature, or any right to participate in the management or control of more than one place of practice. B&P §1658.

Fictitious Name Permits and Additional Office Permits are address-specific. A change in the address of these permits requires a new application.

Name Change

A legal name change must be reported within 10 days. You must submit photocopies or electronic copies of the following two required documents with your Notification of Name Change form:

  1. A current government issued photographic identification (e.g. driver license, alien registration, passport, etc.) AND
  2. One of the following additional legal documents as proof of name change

There is no fee for a name change unless a replacement pocket or wall license is requested. Once the name is changed, the next pocket license will automatically be issued be in the new name.


The fee to replace a pocket license is $50, unless the name change coincides with license renewal.

The fee to replace a wall license is $50 and requires the return of the original wall license.