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Step 1 of 2
Registration
To create your account, please start by providing information about your practice.
*
Fields marked with an asterisk are required.
Tax ID Number
*
Business Key
*
Enter the following details for any of the dentists at your practice.
Provider First Name
*
Provider Last Name
*
License Number
*
Provider NPI Number
*
Processing...
Step 2 of 2
Registration
Now that you’ve provided information about your practice, please provide information about yourself.
*
Fields marked with an asterisk are required.
First Name
*
Last Name
*
Email
*
Username
*
Should be 3 to 18 characters.
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