Dentist Search Sign Up - Lite Form

Shows summary information only

There is no clickable link to your web site

There is no call button on mobile phones

Only listed in the city and zip code of your office

To have the Dentistinfo.com search summary link to your practice web site use the Premium Link registration page. With a Premium Link registration you can add multiple city names and zip codes which are searchable.

Complete the free dentist search Lite-Listing Form below in full. Press the submit button at the bottom of this page to submit the application form. Please mail a copy of your current dental and/or specialty license to:
2001 N. Halsted, STE 202, Chicago, IL 60614.

Dentist Search – Lite Form

Select one:

Name of practice

Address

City

State/Province/Country

Zip Code

Phone

Email

3 plus 6

Select the following Services Provided:
(These will be searchable)

Crowns, Bridges and Dentures (Prosthodontics)
RootCanals (Endodontics)
Extractions Oral Surgery)
Gum Treatments (Periodontics)
TMJ
Children (Pedodontics)
Bleaching, Veneers and Bonding (Cosmetic Dentistry)
Implants
Braces (Orthodontics)

Open on Saturdays or Evenings
welcomes 24 Hr. Emergencies
that uses 90% less radiation (Digital X-rays)
CEREC (1 appointment porcelain restorations) Available

Personal information below (will not appear on web site)

License Number

Years in practice

To the best of my knowledge, all of the preceding answers and information provided are true and correct. If I ever have any changes, I agree to advise Dentistinfo as soon as possible.

After receiving the completed form, Dentistinfo.com reserves the right to reject or edit all applications based on our ethical standards.