Become a Smilers Provider Today

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Customer Information

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I am a/an*

Orthodontist

Dentist

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Practice Name

Last name*

First name*

E-mail address*

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Name or practice name*

Billing address*

Additional info

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Phone number*

Mobile number

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 information 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.