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Indiana Professional Licensing Agency

PLA > Professions > Indiana State Board of Dentistry > Application For Anesthesia Permit Application For Anesthesia Permit


Applicants will need to download all of the following documents listed below to apply for a Dental Anesthesia Permit:

 Application For Permit To Administer Anesthesia & Sedation For Dentists

 Information and Instruction Sheet

 Indiana State Board of Dentistry Statute and Administrative Rules
A compilation from the Indiana Code and Administrative Code.   The Indiana State Board  of Dentistry Compilation from the Indiana Code and Indiana Administrative Code is  available to Download:

  Microsoft Word Version
  Adobe PDF Version

 Indiana Professional Licensing Agency Statute. 
A compilation of the statutes governing professions regulated by the boards and commissions under the Indiana Professional Licensing Agency is available to Download:

  Microsoft Word Version
  Adobe PDF Version

TO ADD ADDITIONAL OFFICES AND/OR HOSPITALS

If wish to add an additional office and/or hospital where you intend to administer general anesthesia, deep sedation, or light parenteral conscious sedation you will be required to submit the following:

    • A written request for an additional office and/or hospital with the dentist name, additional location, license and permit number.
    • A new Emergency Equipment Affidavit.  (A sample affidavit is located on page 4 of the Application for Anesthesia Permit.)
    • A fee of $25.00 for each additional office and/or hospital
If you have any questions regarding adding an additional office and/or hospital where you intend to administer general anesthesia, deep sedation, or light parenteral conscious sedation, please contact our office by calling (317) 234-2054 or by email at pla8@pla.in.gov.