Please Enter Registration Code

*Registration Code:
 
Dental Patient Registration Beta - The Next Generation in Patient Care

Patients registering will be administered by Dr Mark DiRe and Dr Greg Wu. Patient registration is currently restricted to residents of King County, WA. For more information regarding Dr DiRe and his office please click here


Enter the required fields below to complete your basic registration. After activating your account by email* you may login to Experience Dentistry and complete your Dental Health History to save in your digital chart and save you time when arriving to an appointment.
  * Indicates Required Fields
* Name:
* First Middle * Last
Salutation: Sex:
* E-mail Address:  
*Username:  
*Password:  
*Confirm Password:  
Country:
* Address:  
* City:  
* State:
* Zip Code:
Phone:  
* Date of Birth:
Who can we thank for referring you?
* Mobile No:  
If you are completing this form for another person, what is your relationship to that person?
  Yes No
Name:
First Middle Last
Relationship:  
* Verification Code:  
 
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After completing the fields and selecting the 'Submit' button below you will receive a confirmation message at the email address entered above. You will need to click on the activation link in your email before you can login to your account.

  * Check the User Disclaimer to register
  * I certify that the above information is correct