EmailMe Form - Certified Dental Laboratory Renewal Application

The National Board for Certification in Dental Laboratory Technology appreciates your participation in the CDL program. For prompt review of your application, please read the following instructions:

1. Be sure to complete all sections.
2. Allow four to six weeks for processing of your renewal.
3. Remember that annual renewal of laboratory certification requires maintaining compliance with all applicable CDL standards and that a Revalidation Application will be required should a CDL relocate or undergo significant reconstruction.

I. APPLICANT INFORMATION

CDL Number: *

Laboratory Name *

Laboratory Certifications (other than CDL)

DAMAS

ISO

Contact Name (Individual Submitting Application) *

Prefix First Last Suffix

Contact Job Title *

Contact Email *

Laboratory Street Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Mailing Address (if different)

Street Address City State / Province / Region Postal / Zip Code Country / Region

Phone *

Fax

### - ### - ####

Website (if applicable)

Number of CDTs at this location *

Total number of technicians/production employees at this location *

Please Note: This application pertains only to the physical facility described above. Branch laboratories or subsidiaries of the laboratory named must be submitted on separate applications if desirous of certification.

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