Self Serve Portal

Please enter your name exactly as it appears on your government-issued ID. If you are taking a DANB exam, the name in your DANB account MUST match your ID or you may be turned away from the testing center.
First Name*
Middle Name
Last Name*
Address Type*
Street Address Line 1*
Street Address Line 2
City*
State
Zip Code*
Country*
Preferred Email Address*

Phone Type*
Phone Number*
User Name*
Password*
Repeat Password*

Demographics

Last four of SSN and Date of Birth will be kept confidential and will only be released to state regulatory bodies and as required by law.

Date of Birth (mm/dd/yyyy)

Last 4 of Social Security Number

Academy of General Dentistry Number

If you work in a state different than the one in which you live, indicate your work state below:

If you work in a dental office, indicate the type(s) of radiography used:
- Film
- Digital