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Dental Professional Registration

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* First Name:
* Last Name:
* Specialty:
* Username
* Email Address
* Password
* Confirm Password
* Address:
* State:
* City:
* Zip Code:
* Phone:
* Website:

* Check the User Disclaimer to register

* I certify that the above information is correct and that I am a licensed dental practitioner or have the consent of my employer who is a licensed dental practitioner to register for this account.

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*Verification Code:

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We take your security seriously. We safeguard your payment information with SSL (Secure Sockets Layer) when sent over the Internet. SSL encrypts personal information, including your name and payment information, so that it cannot be read in transit by a third party. We also store your payment information in an encrypted format.