How do I submit a request for a name change ?
You submit a request for a name change by clicking the eye icon located on the left panel in your dashboard labeled “ Personal Details .” Be prepared to electronically upload a copy of one of the following name change verification documents : marriage certificate ; divorce decree which indicates the retaking of your maiden name ; passport ; other “ legal ” document indicating the retaking of a maiden name .
How do I update my address with by Board / Commission ?
You can submit an official address change to your licensing record by clicking the eye icon located on the left panel in your dashboard labeled “ Personal Details .”
Chapter 33.202 ( c )
Practices that operate under a fictitious name must notify the state board of any changes in the ownership of a dental facility , changes in the designation of the responsible dentist , changes in the scope of practice or changes in the professional staffing within 10 days .
A Fictitious Name is any name assumed by an individual or business other than the legal name of the individual or business . If a sole proprietor is doing business under a stylized name other than his or her name or a registered business is using a name different from its legal name , this is a fictitious name . Fictitious names are registered with the Pennsylvania Department of State ’ s Bureau of Corporations and Charitable Organizations .
Chapter 33 . 340 ( 6 ) & ( 7 )
Dentists who have an unrestricted anesthesia permit must submit a complete report of death or incident requiring medical care and resulting in physical or mental injury that directly resulted from the administration of general anesthesia , deep sedation , conscious sedation or nitrous oxide / oxygen analgesia by the permitholder , or by a CRNA working under the supervision of the permitholder . The report must be submitted within 30 days of the death or incident .
In addition , the board must receive prior notice of the first time that the office of the permitholder will be used for the administration of general anesthesia , deep sedation , conscious sedation or nitrous oxide / oxygen analgesia .
Chapter 33 . 340a ( 6 ) & ( 7 )
Dentists who have a restricted I anesthesia permit must submit a complete report of death or incident requiring medical care and resulting in physical or mental injury that directly resulted from the administration of conscious sedation or nitrous oxide / oxygen analgesia by the permitholder , or by a CRNA working under the supervision of the permitholder . The report must be submitted within 30 days of the death or incident .
In addition , the board must receive prior notice of the first time that the office of the permitholder will be used for the administration of conscious sedation or nitrous oxide / oxygen analgesia .
2024