Congratulations! You have been Nominated to receive your place on the 2023 Website!

Accept your Nomination Now Below!
$397.00 / per year *

    Select Specialty*

    Dental Practice Location by City*

    Practice Name*

    Name as you wish it to appear on Wall Plaque*

    Dentist or Dental Practice Instagram Handle ig

    Your website:

    E-mail you wish your digital badge to be sent to:*

    CERTIFICATION: By digitally signing (typing) my name below, I certify that all information provided herein by me is true and accurate; that I am a current, active, practicing member of my State Dental Board in good standing; that this award complies with my state's dental rules and regulations; and that I consent to my information herein being published in print and online materials for, including website materials, printed and online member lists, brochures, press releases, member selection announcements and letters, and other membership advertising and announcement materials.

    Sign below (Use mouse or finger to sign)

    * What's included: 2023 Award Acceptance membership which includes your Full dynamic profile, Digital badge, Beautiful custom plaque, Custom stickers, Instagram advertising, Press release.