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Find A Dentist Registration Form

Premium Registration Form

First 3 months free!

Complete the Find a Dentist Registration Form below in full. Press the submit button at the bottom of this page to submit the application form.

Email a copy of your current dental and/or specialty license to: drtooth@dentistinfo.com

Please click on the PayPal button to complete your payment at the PayPal web site. You will then be returned to our site.

Your name, address and phone number will be entered into our database and will be searchable but will only appear in our Dentist Search Results Page which shows summary information only.
Upon approval, your SEO link to your current web site will be accessible to the world.



Select one:



Select the following Services Provided: (These will be searchable!)
Crowns, Bridges and Dentures
Root Canals
Extractions
Gum Treatments
TMJ
Children
Bleaching, Veneers and Bonding
Implants
Braces

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

 Personal Information (Will not appear on Webpage)

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.


I would like to pay for the following period:
1 Year with 3 month Trial Period

Payment Method:

$49.95 yearly payment 

After receiving the completed form, Dentistinfo.com reserves the right to reject or edit all applications based on our ethical standards.  If editing is required you will be notified.

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TheraBreath


Safco Dental Supply


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