Application for Fictitious Name Permit

The Dental Board of California (Board) issues a Fictitious Name Permit to licensed dentists or Oral Maxillofacial Surgery (OMS) permit holders who engage in practice under any false, assumed or fictitious name if they have ownership in the practice and meet all requirements pursuant to Business and Professions Code (BPC) section 1701.5.

A Fictitious Name Permit is required for each dental office engaging in practice under a fictitious name, and this requirement is not met by obtaining a Fictitious Business Name Statement through the county office.

A Fictitious Name Permit is not required by a corporation if practicing under a corporate name in compliance with BPC section 1804. If a corporation wishes to practice under a name other than its corporate name, then a Fictitious Name Permit is required.

A Fictitious Name Permit is not required for an individual practicing under their name with a practice area, e.g., Dr. Terry Jones, General Dentistry; or Dr. Pat Smith, a practice limited to orthodontics.

Application Requirements

Submit a completed application online through BreEZe with payment, or by mail using a paper application.

The paper application can be found at the following link: Application for Fictitious Name Permit, and should be mailed along with a check or money order made payable to the Dental Board of California to the following address:
Dental Board of California
2005 Evergreen Street, Suite 1550
Sacramento, CA 95815

Submit a non-refundable application processing fee of $650.
Proof that all applicant(s) hold an active dentist license, or OMS permit issued by the Board that is not subject to any pending enforcement action.
Submit evidence that the dental practice is entirely owned or leased by the applicant(s), and the practice conducted at the place or establishment is controlled entirely by the applicant(s).
Submit a copy of any supporting documentation listed below if applicable:

Dental offices practicing as a corporation must submit a copy of the Articles of Incorporation for a professional corporation as registered with the Office of the Secretary of State.
NOTE: The Articles of Incorporation for a professional corporation shall contain a specific statement that the corporation is a professional corporation within the meaning of Part 4 of Division 3 of Title 1 of the California Corporations Code.
Dental offices practicing as a partnership must submit a copy of the Partnership Agreement.
Dental offices practicing as an association do not require additional documentation.
Dental offices practicing as an Individual/Sole Ownership do not require additional documentation.

Permit Restrictions

The location where the applicant(s) practice must be “owned or leased by the applicant or applicants, and the practice conducted at that place must be wholly owned and entirely controlled by the applicant or applicants. (BPC § 1701.5, subd. (b)(3).)”

Fictitious Name Permits are address and status specific. Therefore, a new application is required if the practice changes location or status. Such as a change from an individual owner to a corporation.

Fictitious Name Permits are not transferable. If an additional dentist desires to engage in practice under the fictitious name, the fictitious name permit shall be canceled, and a new fictitious name permit application shall be submitted to the board.

Name Style

Pursuant to BPC section 1701.5, subd. (b)(4) states that the fictitious name must contain at least one of the following designations: "dental group", "dental practice", "dental office", or “dental corporation”.

The name may include descriptive language such as regional or geographic references, and may denote a practice area, as long as it is truthful and not misleading.

The fictitious name may be more than one line, and if so, the lines do not have to be of equal font size. Some examples are:

Greenhaven Dental Care

Dental Office of Dr. John Doe

A-B-C Dental

Practice of Smith Dental Corporation

Camellia Dental Center

Dental Group of John Doe, DDS, Inc.

Howe Avenue Dental Group

Drs. Jones, Smith, and Doe

Renewing Your Permit

The fee for renewal is $325.00. If the permit is not renewed within 30 days of the expiration date, a delinquency fee will be assessed in the amount of $162.50. The expiration date of the permit is determined by the last day of the month it was issued plus 2 years. For example, permits issued January 15th of 2025, will not need to be renewed until January 31st of 2027 (Last day of the month plus 2 years.)

Permits must be renewed every two years online through BreEZe. To renew the permit, all associated licensees must have current and active licenses.

Disassociation or Cancellation

Letter of Disassociation for a Fictitious Name Permit

Any departures of dentists engaged in practice under the fictitious name shall be reported by the departing dentist to the Board within 30 days of departure.
If a departing dentist is the dentist whose family name was used in the fictitious name, the remaining permitholders shall apply to the Board to change the fictitious name to remove only the name of the departing dentist.
Current processing times are 4-6 weeks.

Cancellation of Permit

If an additional dentist desires to engage in practice under the fictitious name, or the place or establishment is no longer wholly owned and entirely controlled by the applicant(s), the permit shall be canceled, and a new fictitious name permit application shall be submitted to the Board.
Current processing times are 4-6 weeks.
Important Notice to All Dentists Regarding Death or Incapacity to Practice

Processing Time

The standard processing time for applications is 4–6 weeks. However, an application may be approved in as little as 30 days if the application is fully complete and submitted with all required documentation.

Notice of any deficiencies will be mailed and emailed after application review.
After approval, the permit will arrive to the practice location within 75 days.

For further assistance, please call (916) 263-2300, or by email at dentalboard@dca.ca.gov.