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Board of Dentistry
Submit an Address Change
All licensed dentists and dental hygienists must notify the Board within 30 days of any change of address. [ORS 679.120 (4), ORS 680.075 (4)]. This request must be in writing which includes mail, fax and email. Please do not call the office. Applicants may also use this form to update address information.
Identify yourself
Name:
  OR
License Number:
   
New Address
Home Send Mail Here
Street:
City:
State:
Zip:
Phone:
   
Business Send Mail Here
Business Name:
Street:
City:
State:
Zip:
Phone:
   
Mailing Send Mail Here
Street:
City:
State:
Zip:
   
Email Address
Email Address:
 

 
Page updated: April 04, 2008

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