Apply for a Mobile Dental Facility (MDF) or Portable Dental Operation (PDO) permit - for dentists only

Are you a dentist? Apply here for a Mobile Dental Facility (MDF) or Portable Dental Operations (PDO) permit. Please note this application is not for dental hygienists applying for a MDF or PDO permit.

Board of Registration in Dentistry

The Details of Apply for a Mobile Dental Facility (MDF) or Portable Dental Operation (PDO) permit - for dentists only

What you need for Apply for a Mobile Dental Facility (MDF) or Portable Dental Operation (PDO) permit - for dentists only

Exemptions

Cases where you don't need an MDF or PDO permit:

  • The service is an emergency treatment
  • A patient of record is homebound
  • The services are only dental screening
  • The services are provided:
    • By a hospital or clinic licensed pursuant to M.G.L.c.111, §51-56
    • In a school setting approved by the Commission on Dental Accreditation of the American Dental Association
    • By a local or state government agency pursuant to M.G.L.c.112, §51

Required application attachments

The following apply if you are applying for a MDF or PDO permit:

  • A written statement detailing the scope of services you will provide. Also include the current CDT code for each service.
  • A copy of a schedule and log demonstrating your regular inspection of all emergency drugs and equipment for administering anesthesia & sedation. Include the date(s) and name of the person who last checked drugs and equipment, and the results of the checks. Include a statement that the condition of equipment meets manufacturers’ specifications.
  • A copy of your written protocol for the management of medical emergencies. Include contact information for emergency care after business hours. 
  • A copy of the schedule and content of regular and routine emergency drills
  • A request for on-site inspection by the Board
  • A copy of the schedule, protocols, and procedures for and results of weekly spore testing
  • A copy of DPH Radiation Control Program Certification for the MDF, (M.G. L. c. 111 §5N), if applicable
  • A copy of ownership documents (corporation papers, DBA, partnership agreement, business certificate) for your practice
  • Copy of a logbook or protocol showing compliance with:
    • Handicap access
    • Infection control for equipment and sterilization systems (for MDFs)
    • Access to portable water
    • Access to hand washing and toilet facilities
    • Storage of local anesthesia and emergency drugs (if applicable)
    • Container for deposit of refuse and waste material as required by 310 CMR 73.00
    • Personal protection equipment (for PDOs)
    • Patient protective eyewear (for PDOs)
    • Protocol for maintenance of any other equipment necessary for services you provide
  • A statement indicating the location where you maintain your dental treatment records. Include your protocol describing how a patient may request a copy of their records.
  • Copies of informed consent form and discharge/referral information sheet

For MDFs/PDOs that don't administer anesthesia or local anesthesia:

  • Copies of current BLS certificates for all those providing dental services, dental hygiene services, or assisting in the services you provide

For MDFs/PDOs that administer nitrous-oxide/oxygen, minimal sedation, moderate sedation, or general anesthesia:

  • Copies of current ACLS/PALS or BLS certificates for all those providing dental services, dental hygiene services, or assisting in the services you provide
  • For MDFs:
    • A copy of current Anesthesia Facility Permit and individual anesthesia permit(s), as applicable
  • For PDOs:
    • A copy of current Facility Permit D-P or other current anesthesia permits, as applicable

Application attachments for the MDF Permit

  • Fill out the Required Equipment and Emergency Drugs form on the application
  • A copy of the layout/floor specifications of the MDF

Application attachments for the PDO Permit

  • A statement about emergency drugs (and equipment, if applicable) to be immediately available to the PDO. See the instructions on the application.
  • Photographs of all equipment, supplies, and instruments you will use in the PDO, including sterilizer

Fees for Apply for a Mobile Dental Facility (MDF) or Portable Dental Operation (PDO) permit - for dentists only

  • We accept personal checks, business checks, or money orders. Make it payable to the Commonwealth of Massachusetts.
  • All fees are non-refundable and non-transferable
  • Please don't staple payment to the application
  • Please don't send cash
Name Fee Unit
Initial permit for a MDF or PDO Facility $180 each

How to apply Apply for a Mobile Dental Facility (MDF) or Portable Dental Operation (PDO) permit - for dentists only

  1. Download the applicable application(s) below
  2. Fill out the application(s)
    1. Include the fee(s) and all attachments
  3. Mail completed application(s) and all attachments to:

Massachusetts Board of Registration in Dentistry
239 Causeway St.
Suite 500
Boston, MA 02114

Downloads for Apply for a Mobile Dental Facility (MDF) or Portable Dental Operation (PDO) permit - for dentists only

Contact for Apply for a Mobile Dental Facility (MDF) or Portable Dental Operation (PDO) permit - for dentists only

Feedback

Did you find what you were looking for on this webpage? * required
We use your feedback to help us improve this site but we are not able to respond directly. Please do not include personal or contact information. If you need a response, please locate the contact information elsewhere on this page or in the footer.
We use your feedback to help us improve this site but we are not able to respond directly. Please do not include personal or contact information. If you need a response, please locate the contact information elsewhere on this page or in the footer.

If you need to report child abuse, any other kind of abuse, or need urgent assistance, please click here.

Feedback