National Dental Assisting Examining Board
Bureau national d'examen d'assistance dentaire

NDAEB Certificate Reprint Application

"*" indicates required fields

1Personal Information
2Fees and Payment

Certificate Reprint Request Details

Please complete the following form to request a reprint of your NDAEB certificate.

Original Certificate Name*
Enter your name as it appeared on your original NDAEB certificate. If you do not have a legal last name/surname please enter a period(.) as a placeholder in the last name field.
To assist the NDAEB in identifying your candidate profile, please enter your date of birth.
Select date YYYY dash MM dash DD
To further assist the NDAEB in identifying your candidate profile, please enter your NDAEB certificate number or your assigned 8-digit NDAEB Applicant ID number if you know either number.
Enter the name of your dental assisting program (college).
Enter the year you graduated from your dental assisting program (college).
Proof of Completion Type(s)*
Please select the proof of completion type(s) you will be uploading from your dental assisting program (college). You may select more than one.
Certificate Name Change*
Do you wish to change the name that appears on your NDAEB certificate?
Current Mailing Address*
Enter your current mailing address.
Email Address*
Alternate Email Address
Clear Signature
I request a reprint of my NDAEB certificate based on the details provided on this form.
Select date YYYY dash MM dash DD

ADDRESS

204-2283 St. Laurent Blvd.
Ottawa, Ontario
K1G 5A2

CONTACT

Phone: (613) 526-3424
Fax: (613) 526-5560
e-mail: office@ndaeb.ca

OFFICE HOURS

9:00am – 4:30pm (EST)
Monday to Friday

ADDITIONAL INFO

©2024 NDAEB | All Rights Reserved.