Ready to set up your Dentalle account? Just fill out the following information completely. If you require assistance, email or phone us at (561) 391-9437. Once we receive your completed profile, we will reach out within 1 business day to get you started!
Please enable JavaScript in your browser to complete this form.
Main Contact Person
Second Contact Person
Our office plans to send lab cases
Expiration Date
Security Code
1. I am authorized to represent the organization listed above. 2. I authorize Dentalle Inc. to charge the above credit card for all orders and any additional fees associated with such orders. 3. In the event that the organization listed above has an outstanding overdue invoice due to nonpayment exceeding Dentalle's terms, I authorize Dentalle to charge the above credit card or any other valid credit card on file. 4. I understand that the organization above is responsible for all costs incurred by Dentalle to collect including but not limited to collection, attorney, and legal.