Name and Address Change Information

Address Change

You are required to notify the Indiana Professional Licensing Agency of any address change.

If you have had a change in your home address, e-mail and/or phone number you may log onto your record 24/7 on our website to make these updates. You may utilize the links on the login page if you have difficulty with your User ID or password. Please contact us via phone at (317) 234-2054, via email at pla8@pla.in.gov, or via fax at (317) 233-4236 to report a change of address. You can also submit your address change in writing to:

Indiana Professional Licensing Agency
ATTN: State Board of Dentistry
402 West Washington Street, Room W072
Indianapolis, Indiana 46204

Please include your name, license number or social security number, and both your old and new addresses on any written correspondence.
 

Name Change

You may have the name changed on your licensure records by submitting a legal name change document (marriage certificate, divorce decree, social security card or other legal name change documents). Submit name change requests and documentation by email at pla8@pla.in.gov or by mail to:

Indiana Professional Licensing Agency
ATTN: State Board of Dentistry
402 West Washington Street, Room W072
Indianapolis, Indiana 46204

Please include your name as it is listed now, your new name, and your license number or social security number on all correspondence.