Arizona State Board of Dental Examiners

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General Fees

General Fees

Thank you for choosing to pay for your service with the Board’s online payment option. This form is for paying for your duplicate certificate, license verification, business entity and penalty fees.

Fields marked with an asterisk are required and must be completed prior to clicking Pay Now.

Applicant First Name *

Applicant Last Name *

Applicant Email *

Applicant Phone Number *

Applicant License Number

Products *

Additional Office Triennial Certificate - $25

Duplicate Wall Certificate - $25 (License Number required)

Duplicate License - $25 (License Number required)

License Verification (for Licensure in another state) - $25 (License Number required)

License Verification (for Insurance/Credentialing Company) - $5 (License Number required)

Business Entity Initial Triennial Registration Fee - $300

Business Entity Renewal of Triennial Registration Fee - $300

Business Entity Late Registration - $100

Business Entity Replacement or Duplicate License Fee - $25 (Business License Number required)

Penalty for Failure to Notify Board of a Change of Mailing Address - $100

Civil Penalty

Additional Office Quantity *

Duplicate License Quantity *

Duplicate Wall Certificate Quantity *

Business Entity Replacement or Duplicate License Quantity *

Civil Penalty Amount *

Leave this field blank

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