PLEASE NOTE: The link to the Enrollment Questionnaire is not currently active as we transition to a new funding cycle (2019-2026) and a new National Coordinating Center. We anticipate that the new Enrollment Questionnaire will be available sometime in January 2020. Thank you for your patience.
Only dental professionals who practice in one of the United States or Territories are eligible for enrollment at the limited or full levels. Professionals outside of the United States may enroll at the informational level only.
The Enrollment Questionnaire is completed electronically and requires an email address. A printed version of the questionnaire is available for reference (new version is pending the transition to our new Data Coordinating Center). A printed version of the Enrollment Questionnaire that was used from 2005-2019 is available for historical reference.
If you have any questions, please contact Andrea Mathews, National Dental PBRN Program Manager, by email at firstname.lastname@example.org.