Monitoring N2O – Online Course Registration | Cumberland Academy of Dental Assisting

Monitoring N2O Registration

This is a screening application for us to verify eligibility before you take the Monitoring of Nitrous Oxide online certification course. After we receive your application and verify your status with the board, we will send you a link to purchase and take the online course.

Name(Required)

First Middle Last

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Verification Information

The following requests information about your work status in order for us to successfully submit your application to THEC and the TN Board of Dentistry.

Name of Employer(Required)

Employer Phone #(Required)

Address of Employer(Required)

Street Address Address Line 2 City State ZIP Code

Pay Rate(Required)

Please enter your pay rate per hour.

Your TN Dental License #(Required)

Your Driver's License or State ID #(Required)

Photo of Dental License(Required)

Please upload a photo of your dental license for verification purposes. We will also accept a screenshot from the Tennessee Health Licensure Verification website. Head here: https://apps.health.tn.gov/Licensure/default.aspx

Max. file size: 100 MB.

Photo of Driver's License(Required)

Please upload a photo of the front of your driver's license or state ID for verification purposes.

Max. file size: 100 MB.

Monitoring N2O Registration

Verification Information

615-239-6524 (Call or Text)

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+ 1 541-754-3010