PROFESSIONAL BACKGROUND INFORMATION SERVICE

23460 N. 19th Avenue
Suite 225
Phoenix, Arizona 85027

Phone: 602-861-5867
Fax: 602 861-9656
E-mail: applications@pbisonline.com

For applications, please contact us with the following information:

Name: ________________________________________
Street Address: ________________________________________
________________________________________
City, State, Zip ________________________________________
Telephone: ________________________________________
E-mail Address: _________________________________________
Application Requested Level I____ Level II_____ Level III_____
For Which State:________________________________________
Dental______ Dental Hygiene________By Credentials__________ By Examination____________