Welcome 5 Stars Dental Service Providers & Associates!
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Primary Administrator Details
Admin Full Name*
Admin Email*
Admin Telephone*
Practice Details
Provider Full Name*
Practice/Office Name*
Practice Address/City/State*
Practice Zipcode*
Practice/Office Phone*
Provider Access Email*
I acknowledge that the
Dental Provider Services Agreement
and the
Business Associate Agreement (BAA)
are required documents that must be reviewed and signed before my account can be activated.
I have read and agree to the
Terms of Use
and
Privacy Policy
.
Check here if registering as a Management/Billing Company
Management/Billing Company Details
Company Name*
Company Address*
Company Phone*
Company Email*
Company Contact Person Name*
Select All Applicable Roles for the Admin/Owner User:
Business Owner/Administrator
Dental Service Provider (Doctor)
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