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We are delighted that you have decided to join us in our pursuit to create a healthier nation.

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.

Area of Care
FQHC / CHC
GP-Dental
GP-Medical
Other
Are you Handicap accessible?
Yes
No
What kinds of care insurance do you accept?

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

JOIN LEVEL THREE 

DENTIMED PLUS

$750 mo.

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