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General Inquiries
Dental Board
3605 Missouri Boulevard
P.O. Box 1367
Jefferson City, MO 65102-1367
573.751.0040 Telephone
573.751.8216 Fax
800.735.2966 TTY
800.735.2466 Voice Relay
dental@pr.mo.gov
https://pr.mo.gov/dental.asp
3605 Missouri Boulevard
P.O. Box 1367
Jefferson City, MO 65102-1367
573.751.0040 Telephone
573.751.8216 Fax
800.735.2966 TTY
800.735.2466 Voice Relay
dental@pr.mo.gov
https://pr.mo.gov/dental.asp
Fee Changes
Effective February 28, 2019
- Dental and Dental Specialist application fees will be reduced to $150.00.
- Dental Hygienist application fees will be reduced to $100.00.
Application Forms
- Application for Licensure - Dental Hygienist
- Application for Licensure - Dental Specialist
- Application for Licensure - Dentist
- Application for Licensure by Reciprocity
- Dental Hygiene Permits
- Verification of Licensure
- Verification of Specialty Licensure
- Verification of Specialty Training
- Application for a Permit to Assist the Administration of and Monitor Nitrous Oxide Analgesia
- Application for Expanded Functions Permits
Use these forms for a permit to administer enteral (oral), and/or parenteral (IV) and/or deep sedation/general anesthesia.
- Sedation Application Information
- Application for Pediatric Moderate Sedation Permit
- Application for Pediatric Moderate Sedation Site Certificate
- Verification of Pediatric Moderate Sedation Requirements
- App. for enteral moderate sedation permit
- App. for enteral moderate sedation site certificate
- Verification of Completion of a Missouri Dental Board Approved Course - Enteral Moderate Sedation
- App. for parenteral moderate sedation permit
- App. for parenteral moderate sedation site certificate
- Verification of parenteral moderate sedation requirements
- Affidavit of written protocols for sedation of dental patients
- App. for deep sedation/general anesthesia permit
- App. for deep sedation/general anesthesia site certificate
- Verification of deep sedation/general anesthesia requirements
Use this form to apply for a permit or registration as a non-for-profit entity providing dental services in the State of Missouri pursuant to the provisions of Chapter 332 of the Revised Statutes of Missouri. This goes into effect August 28, 2004.
Use this form to comply with the State regulation requiring the report of a patient injury or death to the Board.