Specialists Registration "*" indicates required fields Personal InformationFirst Name* Last Name* Title (DDS, DMD) Email* Mobile Phone*Street Address* City* State*Select...AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip Code* Professional InformationYour Primary Specialty*Select...EndodonticsGP AssociateOral SurgeryOrthodonticsPedodonticsPeriodonticsRestorative ProsthodontistSurgical ProsthodonticsYour Secondary Specialty (if applicable)Select...Oral SurgeryPeriodonticsSurgical ProsthodonticsPrimary State of LicensureSelect...AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState License Number License Expiration Date MM slash DD slash YYYY Check Each of the Services You Are Comfortable Delivering Full Arch (Restoration) Full Arch (Surgery) General Anesthesia/IV Implant Placement Implant Restorative/Prosthetic C&B Laser/LANAP PRP Surgical Extractions (Most 3rds) TMJ/Myofacial Have You Had Any Issues With your license? Your Daily Production Goal (In Dollars, Ex: $8,000)*How Did You Hear About Us?Select...Cloud DentistryDental NachosE-mailFacebookGoogleInstagramLinkedInOtherSearch EngineWord Of MouthConsent* I AcceptBy registering as a Specialist member of Pair Dental, Inc. (“Pair”), I understand that Pair will attempt to find suitable dental practices to match with. I agree that any practices introduced by Pair are confidential and, before I work with a matched practice, I will need to sign additional agreements with Pair & the practice. I agree that I will not circumvent Pair and will not work directly with a matched practice without signing the additional agreements. I understand and agree that any circumvention can lead to a lawsuit in the Superior Courts of Los Angeles County.
