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To confirm you are an employee of this clinic, please provide the following information.

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New Clinic Registration
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State dental license number.
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Invoices and billing notices will be sent here. You may reuse the Practice Email above.

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You can change this any time in My Account › Practice.
Clinic Verification
Verify the clinic's billing email and phone with a one-time code. Verified values become read-only on the form above; click Reset here to allow editing. Registration is blocked until both are verified.
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A verification code has been sent to your billing email.

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Verify Phone Number

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