Kentucky Board of Dentistry

Lab Information

Welcome to the Dental Laboratory Registration System. It’s easy to register your laboratory online and pay with your choice of ACH Debit (Electronic Check), Visa, MasterCard, American Express or Discover. The registration fee is $150 plus a portal administration fee of 3% for credit cards or $2.00 for ACH Debit transactions.

Please provide the following information:

ex: 000-000-0000

Certified Dental Technicians

Please upload 1 document per CDT

Format: mm/dd/yyyy Ex: 12/31/2019

Supervising Dentists

Please upload 1 document per Supervising Dentist

Format: mm/dd/yyyy Ex: 12/31/2019

Signature

As the supervising CDT/Dentist, I acknowledge that this laboratory will provide material disclosure to the prescribing dentist that contains the U.S. Food and Drug Administration registration number of all patient contact materials contained in the prescribed restoration in order that the dentist may include such numbers in the patient’s record.

As the supervising CDT/Dentist, I acknowledge that this laboratory will disclose to the prescribing dentist the point of origin of the manufacture of the prescribed restoration. If the restoration was partially or entirely manufactured by a third-party provider, the point of origin disclosure shall identify the portion manufactured by a third-party provider and the city, state, and country of such provider.