Practice OwnerRegistrationPlease fill this form out to register your practice to be matched with a specialist.Practice Owner's Information Name * First Name Last Name Title (DDS, DMD) Email * Mobile phone number * Practice Information Practice Name * Practice Street Address * Address 1 Address 2 City State/Province Zip/Postal Code Country * Check here if your practice is specialty based Is your practice part of a larger group or DSO? * Yes No Matching Information Which specialties are you interested in matching with? * Oral Surgery Periodontics Surgical Prosthodontics How did you hear about us? * Please Select Craigslist DDS Dental Nachos Dental Shopper DentalPost DentistJobCafe DP E-mail Facebook Healthgrades HR Job Indeed Indian Dental Association Instagram LinkedIn Other Pair Dental Progressive Purchased List Seamless AI Search Engine Word Of Mouth ZipRecruiter By registering as a Practice member of Alliance Dental. (“Alliance”), I understand that Alliance Dental Services will attempt to find suitable treating providers to match with my practice. I agree that any providers introduced by Alliance Dental Services are confidential and, before I work with a matched provider, I will need to sign additional agreements with Alliance Dental Services & the treating provider. I agree that I will not circumvent Alliance Dental Services and will not work directly with a matched specialist without signing the additional agreements. I understand and agree that any circumvention can lead to a lawsuit in the Superior Courts of San Francisco county. * I accept Thank you!
