Address Change
Update your address (mailing / practice), email or phone number by logging into Online Services.Name Change
- If a licensee submits a name change form prior to, or at the time of renewal, the license certificate will reflect the new name.
- Licensees may submit a name change form along with a renewal. Email dental.board@state.mn.us to request a printable renewal form.
- If submitting a name change along with the renewal and only need one license certificate, then the extra $10 name change fee is not required. Licensees automatically receive one license certificate after renewal.
- Check the box on the name change form indicating the surname you will use for licensure purposes.
- Include a photo copy of the legal document which changes your name. (Marriage certificate, court ordered name change, or divorce decree. If the legal document is a divorce decree then include the first page, the page with your legal name change, and the last page with the judge’s signature.) Only a photo copy produced on a copier machine is needed and not an original. Documents are shredded after processing and not returned.
- The name change form must be notarized.
- We can only accept checks (and money orders, as long as they do NOT say "mobile deposit prohibited") Cash and credit card are not accepted.