Please select the proof of completion type(s) you will be uploading from your dental assisting program (college). You may select more than one.

Select the name change supporting document(s) you will be uploading for your NDAEB certificate name change request.

Before proceeding to the next page, please be prepared to have your credit card information on hand. The payment page is time sensitive and must be fully completed and submitted within a reasonable time. Payments pages not completed in a reasonable amount of time risk the application not successfully being submitted.

Before proceeding to the next page, the credit cardholder must be fully aware of the fees to be charged for the certificate reprint. Disputed charges are not permitted by the NDAEB and in the event the reprint fee and associated charges are disputed by the cardholder, you risk having your reprint request automatically withdrawn.

Before proceeding to the next page, please be advised that the certificate reprint fee and credit card processing fees are non-refundable.