Name Change Form


Pursuant to A.R.S. § 32-1262(H), if you legally change your name and wish that the renewed license, or immediately requested license, be in the new name, please complete this name change form.

NAME CHANGE FORM - online Submission (Once all required fields are completed, a "Click to Sign" button will display at the bottom of your screen.)

Problems With a Dentist, Dental Hygienist or Denturist


Anyone alleging to have been "harmed" by an Arizona dentist, hygienist or denturist may file a complaint against that professional. In order to file a complaint, please complete the online form below and use the second page, of the complaint form, to describe in detail what you are aggrieving. If you were treated by another licensee before or after the treatment you are now complaining, please provide the contact information for each licensee. If the list of licensees is more than two, please use the link, on the complaint form, to attach a comprehensive list. Lastly, please place the links on

Registration to Dispense Drugs and Devices

Other Applications

Pursuant to A.A.C. R4-11-1406, a dentist licensed to practice in Arizona may dispense controlled substances, prescription-only drugs and/or prescription-only devices for profit if the dentist completes a registration approved by the Board and submits a copy of their DEA Certificate of Registration. 

Dispense means the delivery by a dentist of a prescription drug or device to a patient, except for samples packaged for individual use by licensed manufacturers or repackagers of drugs, and includes the prescribing, administering, packaging, labeling and security necessary to prepare and