Get Tx Tsbde Dental Laboratory Renewal Form 2020-2025

Renewing your dental laboratory registration can be a straightforward process when following the correct procedures. This guide provides clear, step-by-step instructions for filling out the Texas State Board of Dental Examiners Dental Laboratory Renewal Form online to help ensure a successful renewal.

Follow the steps to complete the renewal form with ease.

1. Click ‘Get Form’ button to access the renewal form and open it for editing.
2. Begin with the basic information section. Enter your lab name and TX lab registration number in the provided fields. Ensure that all details are accurate.
3. Fill in your physical address, including city, state, and zip code. If your address has changed, mark 'Yes' to address change and provide the new details.
4. Input your primary contact information, including phone number and email address. Verify that all contact details are current.
5. Next, move to the laboratory owner information section. Enter the owner's name, and indicate if there is a new lab owner since your last renewal.
6. Provide the physical mailing address for the laboratory owner, along with their contact information in the specified fields.
7. Continue to fill in the laboratory manager information. If the laboratory manager is the same as the owner, simply write 'same' in the name field.
8. In the certified dental technician (CDT) of record section, enter the CDT's name and state whether there is a new CDT since the last renewal.
9. List all individuals with a 20% or greater ownership interest in the laboratory completely, providing their name, address, ownership percentage, and date of ownership interest obtained.
10. Address any disciplinary actions or criminal offenses by responding accurately to the questions and preparing a separate signed and notarized affidavit if necessary.
11. Lastly, sign and date the form, thereby confirming that your laboratory complies with all applicable regulations and requirements.
12. After completing the form, ensure all information is double-checked. You can then save your changes, download, print, or share the completed form as needed.

Complete your TX TSBDE Dental Laboratory Renewal Form online today to maintain your laboratory's active status.