Unlock the full benefits of the Dental Prophet$ Webinar Series membership. Gain exclusive access to valuable insights with advance email notifications.

Once you submit this form along with your payment, you can expect to receive an email from us. The email will contain NEXT STEPS to get you on-boarded, with links, examples and access to some materials you can brand with your practice info.

Provider First name*

Provider Last name*

Practice Name

Email

Phone

Area of Care*

FQHC / CHC

GP-Dental

GP-Medical

Other

Primary Office Address*

Are you Handicap accessible?*

Yes

No

Number of additional offices*

Name of Primary Office Contact *

How many patients do you see per month?*

What kinds of care insurance do you accept?*

DHMO

PPO

Medicaid

Medicare / Medicare Advantage

No Insurance Accepted

Other

Insurance: If "Other", please explain

Once you submit, you will be prompted to pay your fee.

JOIN LEVEL ONE

ORAL HEALTH INSTITUTE

$150 year

bottom of page