New Office Form

The New Office Form is for dental offices that are new to Dynamic Digital Dental Lab and need to register for our website.

All you have to do is fill out some basic information about your dental clinic, and we’ll enroll you on the Dynamic Digital Dental Portal.
From there, you can tell us what your restorative preferences are by filling out a Dentist Preferences Form.

If there are multiple providers, please have each provider fill out their Dentist Preferences Form.

New Office Form

Dentist Preferences

RX Forms

Smile Shapers RX Form

Dentist Referral

"*" indicates required fields

Step 1 of 2

First Name*

Last Name*

Practice Name*

Dentist NPI #*

Address Line 1*

Address Line 2

City*

State*

Zip Code*

Office Phone Number*

Hidden

Zip Code*

Please enter a number greater than or equal to 0.

Dentist’s Cell Phone

Email Address*

Preferred Account Username*

What Digital Impression System Does Your Practice Use?