![]() ![]() You may be eligible for the Dental Board's reduced fee program if you: If you choose, you may also submit any treatment records or X-rays, as well as letters or documents from your attorney.Īpplication for New License to Replace Cancelled License Reduced Fee / Retired Status Providing these documents at the time of application will expedite the review of your application. Also, if applicable, court where case was filed, case name, case number, and documents, a copy of complaint, transcripts, depositions, etc. If you have used another name since your last renewal, you must submit a completed Notification of Name Change form, with required documentation.įor any yes response (above the arrow on the application) you need to provide a detailed letter of explanation. ![]() Call the Board for a determination of the appropriate fee to submit with your application. The fee is based upon the expiration date of the cancelled dental license, delinquency fees, and current examination fees. To apply for a new license to replace a cancelled license, submit a completed application form with applicable fees. Wall license: $50 New License to Replace Cancelled License X-ray License Replacement Request This application applies only to dentists' X-ray licenses granted prior to 1985. If submitting cards, you must add an additional $49 to the fee for a wall license to pay for processing of the cards by the Dental Board. If applying from out-of-state and not able to come to California for fingerprinting, go to a local law enforcement agency and have two sets of fingerprints made on cards with ink. If you cannot return the original as required pursuant to California Code of Regulations § 1012, take this California Live Scan fingerprint form to a service location. Replacement of a wall license requires the return of the original wall license. ![]()
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