eCentral v3.5
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ECENTRAL REGISTRATIONS
HELP Registration Wizard > Practice Setup

Please enter your information and then select the 'Continue to Select Packages' button at the bottom of the page to save your changes.
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Contact Information
First Name: MI:Last Name: Title:

Practice Information
Practice Name: Customer ID:Contact Name:
Mailing Address: City:
State: Country: Zip:
Phone: Fax:
Email: Time Zone:
Tax ID Number*:NPI Number*:
*(When using "Patient Eligibilities", some insurance companies require these numbers.)

Dental Software Currently Used:

Specialty:
Dental Assistant General Practice Pediatric Dentistry
Dental Hygienist Oral and Maxillofacial Periodontics
Dental Public Health Orthodontics Prosthodontics
Endodontics Other 

Product Information
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