Practitioner List Request

To obtain a list of Dentists, Dental Hygienists, Registered Dental Assistants, Radiographers, or Dental Entities please complete the following form. The information is available electronically in an Excel format and will include: License/Registration number, Name, Office Address, Original License Date, License valid through date, and Specialty (if applicable).  

Practitioner List Request Form

Page Updated: 7/29/2019 9:21:35 AM