Florida

Board

of

Dentistry

Name changes require legal documentation showing the name change. To change your name, please submit supporting documents, which must be one of the following:

1. A copy of a state issued marriage license that includes the original signature and seal from the clerk of the court.
2. A divorce decree restoring your maiden name.
3. A court order showing the name change (adoption, legal name change, federal identity change).
4. A copy of a certificate of naturalization or H1B Employment Visa (Note: Foreign applicants and/or licensees may not have state issued documents)

Any one of these will be accepted unless the department has a question about the authenticity of the document.

The Division of Medical Quality Assurance is now issuing electronic licenses, which enables you to download a PDF copy of your license within two business days. The license can be retrieved in the License Documents menu of your MQA Online Services Portal, https://mqa-vo.doh.state.fl.us/datamart/voservicesportal account. To learn more, please visit the electronic licensing webpage at https://flhealthsource.gov/electronic-licensing/.

For requests by mail, please include your full name as it appears on your license, profession, license number, your new name, your date of birth, the last four digits of your social security number, and your signature. Please submit your name change along with supporting document(s) 5-7 business days to allow processing if you need to renew online.

If you do not require a new license to reflect your new name, you may submit your request online or by mail along with legible supporting document(s) to one of the following:

•  Log onto your MQA Online Services Portal account , select “Request Name Change” from the “Manage My License” dropdown menu
• Mailing address – DOH, Division of Medical Quality Assurance, Post Office Box 6320, Tallahassee, Florida 32314-6320

Login to your MQA Online Services Portal account and select Request Duplicate License from the “Manage My License” pulldown menu. Review your changes and click “Submit.”

NOTE: If your profession is pending renewal or in a current renewal cycle, you may be asked to renew your license instead of being issued a duplicate license.

UPDATE ADDRESS ONLINE:

•  Login to online services by selecting your profession from the dropdown menu and entering your User ID and Password
•  Your User ID and Password were mailed with your initial license. Please look at the center section and refer to the Online Services Instructions, item #5.
•  If you do not have your User ID and Password, click on “Get Login Help“.
•  Select “Update Addresses” on the left side of the page
•  Enter the new address information
•  Once you have entered your new address, click on “Process”. You will receive a confirmation page that displays the updated address.

About Your Practice Location Address

The practice location address will display on the Internet and your license. Your practice location must be a physical location address and must not include a Post Office box. The mailing address will only display on the Internet if you have not provided a practice location address to us.

Establishment/Facility Name or Address

If the name or address change is for a facility that has changed location, a licensure application must be submitted. See your profession’s web page for additional information.

UPDATE ADDRESS BY MAIL: If you prefer to change your address by mail, please complete the Change of Address form. Written requests for address changes must include your name, profession, license number, old address, new address, date of birth, last four digits of your social security number, and your signature.

PROCESSING TIME: If you are submitting an address change request by mail, please allow 5-7 business days for processing. Online requests will be processed within 48 hours.

The Division of Medical Quality Assurance is now issuing electronic licenses, which enables you to download a PDF copy of your license within two business days. The license can be retrieved in the License Documents menu of your MQA Online Services Portal, https://mqa-vo.doh.state.fl.us/datamart/voservicesportal account. To learn more, please visit the electronic licensing webpage at https://flhealthsource.gov/electronic-licensing/.

A dental hygienist who has completed the required training course as stated in s. 466.017, F.S., may be certified to administer local anesthesia upon application to the board. Complete the application and mail proof of course completion and current CPR certification, along with the fee of $35.00. Visit our Licensing page for further requirements and to download a copy of the dental hygiene application for administration of local anesthesia.

You must submit a signed request in writing. Mail your request to:

Board of Dentistry
4052 Bald Cypress Way
Bin #C08
Tallahassee, Florida 32399-3258

You may also fax your request to (850) 921-5389.

You may apply for your license by visiting our Licensing and Registration page.

If you are submitting a name or address change request by mail, please allow 5-7 business days for processing. Online requests may be processed within 48 hours.

Please Note: An updated license will not automatically be sent. A duplicate license request must be submitted if a duplicate license is required.

You can print a confirmation of license through the Practitioner Login feature of MQA Services. The confirmation is available up to 30 days after you submit your online renewal request. After logging into the system with your User ID and password, select Print Confirmation of License from the navigation bar located on the left.

If you receive an error when trying to print your temporary license, the file was most likely corrupted during the download process. To correct the problem, you will need to first clear your browser’s cache, then close and restart the browser, which entails logging back into MQA Services to continue downloading the document. If the cache is not cleared the cached version of the document, which is likely damaged, will still appear.

If you need a written statement on a public record attesting to the record’s genuineness or that it is a true and correct copy, you may fill out the Online Request Form. Be sure to indicate you need a certified copy of the request form. A $25 fee will be charged, in addition to the public record Fees and Charges. Visit our Public Records page for information on how to request certified documents by mail.

You may check the status of your application in real time via our online services, using your User ID and password. If you lose your User ID and password, contact Licensure Support Services at (850) 488-0595 to get this information.

Note: We are in the process of making this service available to all professions. However, if your profession is not yet online, you must contact the board office directly to check on the status of your application.

For Dentists, Medical Doctors and Osteopathic Physicians – To provide expert testimony concerning the prevailing professional standard of care, you must either be licensed in Florida OR you must possess an expert witness certificate.
To apply for an “Expert Witness Certificate”:

• Go to our Online Application Login page

• First time users must create an account by clicking on the “Create an Account button” and following the prompts

• Once you have created an account, select your profession from the “Board/Council” drop down menu

• Under the “Profession” drop down menu, select either “Dental Expert Witness Certificate”, “Medical Doctor Expert Witness Certificate” or “Osteopathic Physician Expert Witness Certificate”

• Enter your email address and password and click “Login”

You may learn more and request public record and/or disciplinary documentation or view Declaratory Statements by visiting our Public Records website.

You may visit our online License Verification where you may utilize the service to see if the status of your providers license and whether there are any disciplinary cases or public complaints against the licensee.

You may visit the Enforcement webpage for more information.

Make cashier’s check or money order payable to the Board/Council to be researched, in the amount of $25.00, for each verification requested

• Include name and address where verification is to be sent
• Verification of Licensure order form
• Non-Licensure Verification order form

Mail your request and fee to:

Division of Medical Quality Assurance
Licensure Support Services
Attn: License Verifications
P.O. Box 6320
Tallahassee, FL 32314-6320

Other Important Information:

• Requests for licensure verification received without the appropriate fee will be returned unprocessed to the sender.
• The Division of Medical Quality Assurance cannot guarantee your verification will meet the deadlines for other State Boards. The current processing time for licensure verifications is approximately 10 days from receipt. Please check your deadline dates before you submit your verification request.
• Release forms from the licensees are not required for verifications.

Exemptions: Financial information, medical information, school transcripts, examination questions, answers, papers, grades and grading keys, are confidential and exempt forms pursuant to Section 119.071, Florida Statutes, and will be withheld pursuant to Section 456.057, Florida Statutes. Social Security numbers will also be redacted pursuant to 42 U.S.C. 405(c)(2)(C) (vii)(1).

You may apply for provider status at www.cebroker.com. The board office will receive notification through the CE Broker system that your application is available for review and we will notify you promptly of any deficiencies.

You can view, confirm, or make changes to the information that will be published in your Practitioner Profile by logging in to. In carrying our legislative mandate to publish practitioner profiles, we want to ensure the information that we publish is accurate. Accordingly, we ask that you please review your profile for any changes, corrections, and/or omissions. If you see the statement “€œThe practitioner did not provide this mandatory information”€, please provide that information. We will not accept curriculum vitae or resumes in place of you providing specific information. Changes, excluding education and training, year began practicing, and liability claims, can be made to your profile electronically by following the instructions below. You may also submit changes by mail to:

Department of Health
Licensure Support Services
4052 Bald Cypress Way, Bin C-10
Tallahassee, Florida 32399-3260

Please note that Section 456.042, Florida Statutes, requires practitioners to update profile information within 15 days after a change of an occurrence in each section of your profile. Attention Newly Licensed Practitioners Section 456.041(7), Florida Statutes, requires you to submit changes to the department within thirty (30) days from receipt of notice. If you do not make changes within thirty (30) days, your profile will be automatically published. Once you have completed your review and made any necessary corrections, click on “€œConfirm Changes”€. The Practitioner Confirmation Page will display the information that will be published online, at which time you must “€œConfirm”€ the profile again before the changes will be implemented. Note: Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.

You may use our License Look-Up Search screen.

Any substantially affected person (i.e. a licensee or applicant) may seek a Declaratory Statement. Declaratory statements regarding an opinion of a board, or the department when there is no board, as to the applicability of a statutory provision, or of any rule or order of the board, or department when there is no board, as it applies to the licensees particular set of circumstances, pursuant to Section 120.565, Florida Statutes. The petition seeking a declaratory statement must state with particularity the licensees set of circumstances and must specify the statutory provision, rule, or order that the licensee believes may apply to the set of circumstances.

Visit our Enforcement Website to download and complete our Unlicensed Activity Complaint Form. Before completing your complaint form, please be sure to review all instructions provided on the first page.

You may learn more about the Complaint process and submit the appropriate complaint forms by visiting our online Enforcement website.

You may visit our online License Verification page. You may utilize this service to see the status of your providers license and whether there are any disciplinary cases or public complaints against the licensee.

If you need a written statement on a public record attesting to the record’€™s genuineness or that it is a true and correct copy, you may fill out the Online Request Form. Be sure to indicate you need a certified copy of the request form. A $25 fee will be charged, in addition to the public record Fees and Charges. Visit our Public Records page for information on how to request certified documents by mail.

The department will mail a renewal notification to your last known address at least 90 days prior to the expiration of your license. Your license also indicates the date it will expire.