New Dentist Registration New Dentist Registration New Dentist Registration You must be an active dentist in practice no more than 5 years. You will be required to upload proof. Name * First Last Name * Last Address Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Email Address * Phone Number * Upload Certificate, License or other proof * Drop a file here or click to upload Choose File Maximum file size: 104.86MB IF you are unable to upload a scanned or electronic version of your proof of your dental certificate, please email documents to sstone@ndaonline.org or fax to 240-297-9181. reCAPTCHA If you are human, leave this field blank.
