Anyone who is licensed or certified and is an ethical practitioner of dentistry or dental hygiene in the state and who is of good moral character, who shall desire to change residence to another state, territory, the District of Columbia or to a foreign country, upon application to the board, shall receive a special certificate or endorsement signed by the secretary and bearing the seal of the board, which shall attest such facts, the date of licensure or certification and such other facts as may be deemed necessary. The nonrefundable fee for each certificate or endorsement shall be set by the board.