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 permit is required for each dental office, 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.

Application Requirements

  • Submit a completed application online through BreEZe or by mail using a paper application. The paper application can be found at the following link: Application for Fictitious Name Permit. It should be mailed to the following address:

    Dental Board of California
    2005 Evergreen Street, Suite 1550
    Sacramento, CA 95815

  • Pay a non-refundable application fee of $650 if the qualifying dentist license or OMS permit will expire more than one year from the date the application is received. Pay a non-refundable application fee of $325 if the qualifying dentist license will expire less than one year from the date the application is received.
  • Hold a valid, current dentist license, or Oral Maxillofacial Surgery permit issued by the Board.
  • Submit a copy of any supporting documentation listed below if applicable. If your practice is registered as a corporation, please submit a copy of your Articles of Incorporation for a professional corporation as registered with the Office of the Secretary of State.

    NOTE: The Articles of 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.

    • If your practice is registered as a partnership, please submit a copy of your Partnership Agreement.
    • Associations and Individual/Sole Ownership do not require additional documentation.

Renewing Your Permit

A permit expires when the qualifying dentist license or OMS permit expires and must be renewed every two years through BreEZe. 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.

In order to renew the permit, all associated licensees must have current and active licenses.

Permit Restrictions

The location where the applicant or applicants 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. (c).) Accordingly, permits are address-specific, and 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.

Processing Time

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

Name Style

BPC section 1701.5, subd. (c) states that the fictitious name must include at least the family name of the applicant or one of the applicants, or the name(s) of one or more of the past, present, or prospective associates, partners, shareholders, or members of the group, as well as one of the following designations: "dental group", "dental practice" or "dental office".

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

Disassociation or Cancellation

Letter of Disassociation for a Fictitious Name Permit

Cancellation of Permit

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