On a form provided by the Board, a dentist shall advise the Board of the name and address of each location where the dentist wishes to administer anesthesia and sedation. A dentist may not administer anesthesia and sedation unless the dentist has obtained the appropriate permit for each location. On a form provided by the Board, a dentist shall advise the Board of each location at which the dentist has ceased to administer anesthesia and sedation. The Board shall keep a record of: Each location for which a dentist has been granted a permit to administer anesthesia and sedation; and Each location at which a dentist has ceased to administer anesthesia and sedation.