Registration

Dentists! Looking for a way to drive more patients to your practice? Then fill out the form below to become a featured Dentist on HealthyTeethAlabama.com. We match patients seeking top quality dental care with great local Dentists in their area.

Did you know that each year over 2 Million Alabamians do not go to the dentist? And over a Million of those have Dental Insurance! Healthy Teeth Alabama is a joint effort among dentists in Alabama to encourage the population of Alabama to regularly see the dentist. We use various forms of media including Radio, TV, Billboards, and Internet to get our message across. We believe that by working together to educate, we will all have plenty of patients. If we Support our Career, our Career will Support us!

Please fill out the form below in its entirety. After you submit the information, a representative from Healthy Teeth Alabama will contact you shortly.

Name*

Company Name*

Practice E-mail (This email will be displayed on the website)

Personal E-mail *

Website

Address

Zipcode*

Dental Specialties
General Dentist (Adults)
Dentist for a Child (Pediatric)
Root Canal (Endodontist)
Wisdom Teeth (Oral Surgeon)
Periodontist
Braces (Orthodontist)
Insurance/Payment
Self Pay/ Out of Pocket
Office Files Insurance for Patients
Medicaid
Mobile Number*

Office Phone number*

Give a One Line Sentence about your Practice that you would like listed on the Site