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Dentist Provider Application

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National Implant Network — Provider Application

Apply to receive pre-qualified implant opportunities in your ZIP-based territory.

✓No contracts

✓No monthly fees

✓High-intent implant inquiries

✓ZIP-based routing

✓Privacy-first intake

We help qualified implant patients find the right provider locally — while protecting your team's time, territory, and intake quality.

Higher-quality leads Patients are screened for intent, timing, and location before routing.
No long-term commitment Join without contracts or subscription pressure — participation stays flexible.
ZIP-based exclusivity Routing respects your primary ZIP and service radius to avoid overcrowding.
Aligned incentives No volume games or junk traffic — the system is built for real consultations.
Fast, human onboarding We confirm routing, expectations, and response times before going live.
Front-desk friendly Fewer tire-kickers, more prepared patients — less intake friction.

🔒 Secure provider application • Used only for territory review & onboarding No marketing spam • Your information is never sold

Name Of Practice *

Primary Contact (Full Name) *

Practice Email *

Practice Phone Number *

Select...

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Primary Practice ZIP Code: (Limited Availability) *

Service Radius Miles (Territories are exclusive. Radius selection is subject to availability.) *

Territory Acknowledgment *

Annual Implant Volume *

Financing Offered *

Yes

Secure provider application • Used only for territory review & onboarding • No marketing spam

What happens after you apply

We keep this lightweight. No contracts, no pressure — just a quick eligibility check to protect territory quality and route the right opportunities.

Territory review & eligibility check

We confirm your ZIP coverage, routing fit, and onboarding readiness.
Short confirmation call (10–15 minutes)

A quick call to verify details, expectations, and the best way to route.
Go live for qualified implant opportunities

Once approved, you'll receive matched opportunities based on your territory.