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Doctor Details
First Name
Last Name
License Number
Mail ID
Password
No. of Years in Practice
Practice Details
Practice Name
Address Line 1
Address Line 2
Country
State
City
Zip Code
Contact Name
Contact Number
Add another address
Type of Dentistry
General-Dentistry
Family-Dentistry
Maxillofacial-Surgery
Prosthodontics
Cosmetic
Implant
Orthodontics
Reconstructive-Restorative
Others
Other - Type of Dentistry
Type of Practice
DSO
Private practice
Provider Group
Name
What Practice Management System do you use:
Select Practice Management System
Simplex Himes
Curve Dental
ACE Dental
Dentrix
Denticon
Carestream Dental
Practice-Web
Dentisoft Office
Datacon
Dovetail
Others
Other - Practice Management System
Which labs currently do you work with:
Case Type
Traditional
Digital
Scanner Name
iTero
Trios
Carestream
Planmeca
Others
Other - Scanner Name
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