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Verification of Licensure Request Form

ASBDE License Verification Request Form

Complete this form and submit if you want the Arkansas State Board of Dental Examiners to provide an official verification of your license or permit.

My Information

Name(Required)
I am requesting verification of(Required)
Address(Required)

License Verification Recipient Information

How do you want the verification to be sent (check one)?(Required)
Recipient's Address

The Arkansas State Board of Dental Examiners will provide official verification of your license/permit. We will not provide specific examination information (i.e scores and test results). If you choose the “mail” option, your verification will be sent via regular mail only.

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