Sign Up for a Dental Practice Account

Create your Primary Account

This is the primary log-in for your account. Once your account is set up you can add accounts for other people in your practice as well.

Salutation

First Name *

Last Name *

Role *

Email *

Confirm Email *

Password *

Confirm Password *

DDX Notifications DDX Newsletter

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Practice

Please tell us about your Dental Practice.

Practice Name *

Address *

Address 2

Country *

State / Province *

City *

Zip / Postal Code *

Telephone *

Time Zone *

Website

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Terms & Conditions

I agree to the Terms of Use *

I accept the Privacy Policy *

Verification Code *

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Possible Duplicate Account(s)