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Request an address change, name change, or duplicate license for dentistry
If you are a dentist, dental hygienist, or dental assistant, and need to change your address or your name on your license, you can request those changes here. You can also request a duplicate license.
Contact for Request an address change, name change, or duplicate license for dentistry
Board of Registration in Dentistry
The Details of Request an address change, name change, or duplicate license for dentistry
Fees for Request an address change, name change, or duplicate license for dentistry
You need to pay a fee if you are requesting:
- To change your name and receive a license with your new name
- A duplicate license to replace a missing license
There is no fee for just changing the address on your license. You can do so online by going to the Board’s website.
Please note that you can't go online to change your name or address on an individual or local anesthesia permit. You must send us a written request and payment for a new permit with your updated information.
Forms of payment
- 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 |
|---|---|---|
| Duplicate license | $17 | per license |
| Name change with new license | $27 | per license |
How to request Request an address change, name change, or duplicate license for dentistry
- Download the Change of Address or Name and Request for Duplicate License | (DOC).
- Fill out the application and include the required fee(s), if applicable
- Mail to:
Bureau of Health Professions Licensure
Attn: Board of Registration in Dentistry
239 Causeway St.
Suite 500
Boston, MA 02114
Please note: Name changes must be submitted via mail with applicable attachments. All requests for duplicate permits must be submitted by mail.
For requesting address changes and/or duplicate licenses, you can login to our Online Licensing Portal.
Downloads for Request an address change, name change, or duplicate license for dentistry
Contact for Request an address change, name change, or duplicate license for dentistry
Address
239 Causeway St, Suite 500, Boston, MA 02114
Phone
Fax
(617) 973-0980