Select your first language (the language of your birth). If you speak additional languages, click Add Another Language. Then, select the language(s) and the level of your proficiency in each.
Indicate whether you have ever had any certification, registration, license, or clinical privileges revoked, suspended, or in any way restricted by an institution, state, or locality. If yes, enter an explanation in the spaces provided.
Enter your DENTPIN. This is a unique identification number that is assigned by the American Dental Association. Visit the American Dental Association site for more information or to obtain a DENTPIN.
Relatives in Dentistry
Indicate if you have any relatives who are associated with the dental profession (this includes professional work, education, and related experiences). Then, enter their name(s) and additional details.