Member Practice Directory Update

Patients Are Looking for You

As a benefit to our members, the NDA is developing an online directory to allow potential patients to view practice information for members in their area. To participate, we will need as much information about your practice as you are willing to share. Please complete the form below so we can ensure your membership records are updated and reflective of your most recent information.

Dentist Member Directory Info

Collect professional info from members for the Dentist Directory.

Professional Information

Name(Required)

First Last Suffix

List Relevant Credentials (Initials Only)(Required)

Specialties

Dental School(Required)

Graduation Year

Birthday

Office Contact Information

Office Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Office Phone(Required)

Business Email(Required)

Website(Required)

Social Media Accounts (List All That Apply w/ Account Name and URL

Office Hours of Operation(Required)

Local Society Affiliation

State Society Affiliation