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Indiana Professional Licensing Agency

Indiana Professional Licensing Agency

PLA > Professions > Indiana State Board of Dentistry > Dental Anesthesia and Sedation Permit Information Dental Anesthesia and Sedation Permit Information

To Add Additional Offices and/or Hospitals

To add an additional office and/or hospital where you intend to administer general anesthesia, deep sedation, or light parenteral conscious sedation you will be required to submit the following:

      • A written request for an additional office and/or hospital with the dentist name, additional location, license and permit number.
      • A new Emergency Equipment Affidavit.  (A sample affidavit is located on page 4 of the Application for Anesthesia Permit)
      • A fee of $25.00 for each additional office and/or hospital.