Become a Smilers Provider Today

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Customer Information

Language*

Country*

If your country is not listed, please contact our sales department.

I am a/an*

Dentist

Orthodontist

Gender*

Ms.

Mr.

Are you a Henry Schein client?*

yes

Practice Name

Last name*

First name*

E-mail address*

I want to have my delivery to another address

Tax ID number ( i.e. VAT, TIN)

I don't have a tax ID number

National business identification number (i.e. EIN, CRO)

Dental license number

Additional information

I own an ATP38 photobiomodulation device

I have taken a Smilers clear aligner training.

I have completed a clear aligner training course not associated with Smilers

To register for a Smilers® clear aligner training, please visit the Smilers website.Biotech Dental Academy

Certificate

I consent that the practice address provided in this registration form may be published on the Smilers website's "practitioner locator" map, so that patients looking for aligner treatment can contact my practice.