Get Danb Name Change

Changing your name with the Dental Assisting National Board requires completing the Name Change Request form. This guide will walk you through each section of the form to ensure it is filled out correctly and your request is processed efficiently.

Follow the steps to complete the Danb Name Change request.

1. Press the ‘Get Form’ button to access the Name Change Request form. The form will open in an online editor for you to complete.
2. Carefully fill out your current name in the designated fields. Enter your last name, first name, and middle initial.
3. Input your previous name exactly as it appears in DANB's records. Ensure to include your last name, first name, and middle initial in the appropriate boxes.
4. Provide your home address, including your city, state, and zip code. Make sure to verify the information for accuracy.
5. List your contact numbers in the specified fields. This includes your office phone, home phone, and cell phone numbers.
6. Enter your email address to receive confirmation regarding your name change request.
7. Read the declaration at the bottom of the form and sign where indicated. Include the date of your signature.
8. Once all fields are completed, review the entire form for accuracy. You may then save your changes, download, print, or share the form as needed.

Complete your name change request online today to ensure your information is updated with DANB.