Board of Dentistry Renewal Documents

To renew your Dental license by paper you must select a form below.  Print and mail the completed form with the required renewal fee to the Indiana Professional Licensing Agency.  The address is on the form and checks should be made out to 'Indiana Professional Licensing Agency'. 

Dental Renewal
Dental CSR Renewal
Dental Anesthesia Permit Renewal

Dental Hygienist Renewal
Dental Hygienist Anesthesia Permit Renewal

Dental Instructor Renewal
Dental Instructor CSR Renewal

Mobile Dental Facility Renewal

Limited Dental Residency Renewal