Request A Duplicate Registration Certificate

  1. A Mobile Dental Facility or Portable Dental Unit owner must complete this application.
  2. Mail the form and your non-refundable fee to the Texas State Board of Dental Examiners (TSBDE) at the address listed at the top of the application. Payment can be made by check, money order or cashiers check (do not send cash). Please make payment payable to the TSBDE.
  3. If requesting more than one certificate, please pay the required fee for each certificate requested.
  4. Please allow two weeks for processing. Your annual registration certificate will be mailed to your address on file with the TSBDE. If your address has changed, include a TSBDE Change of Address Form with this request form to avoid delays in receiving your annual registration certificate.

Duplicate Annual Registration Certificate Request Form