Accreditation application - The American Board of Advanced General Dentistry

1) Personal Information

Full Name*

Date of Birth*

Nationality

Email*

Mobile/WhatsApp*

Postal Address*

License Authority*

License Number*

License Expiry*

Dental Degree (school & year)*

Postgraduate Programs/Residencies

Board Certifications/Memberships

Years in Practice*

Primary Practice Setting*

Focus Areas

CE Hours (last 24 mo)*

CE Summary / Certificates*

Part I Written Exam*

Part II Oral Exam*

Accommodation Request (optional)

Note: Part II scheduling occurs only after eligibility and Part I results.

I attest that I am in good standing with my licensing authority and agree to abide by ABAGD policies, security rules, and Code of Ethics.

I certify that all information submitted is true, complete, and accurate to the best of my knowledge.

An invoice and payment options will be sent after review and approval. Do not send card details by email.

Ask a Question