Register New Practice - Dental Claims Management

Register New Practice

Create a new dental practice account with administrative access

Practice Information

Practice Name:

NPI Number:

Tax ID/EIN:

Phone Number:

Practice Address

Address Line 1:

Address Line 2:

City:

State:

ZIP Code:

Contact Information

Practice Email:

Website:

Administrator Account

This will be the main admin account for your practice

Admin First Name:

Admin Last Name:

Admin Username:

Admin Email:

Admin Password:

Confirm Password:

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