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MembershipCornelia Outten2019-12-12T10:35:41-05:00

You face many challenges operating your dental practice and it is our mission to enhance the quality of time and services from dentist to patient by pre-negotiating non-clinical business functions that would otherwise occupy time better utilized for clinical care.

We accomplish this through four types of memberships: Practice Level Membership (Dentists), Office Manager Membership, Student Level Membership and Supplier Level Membership*.

Dental Practice Membership

Exclusively for Dentists

Dental Practice Membership

Perfect for Dental Practices and Dentists!

View Membership Benefits

Dental Practice Membership Form

Practice Name*
Address*
Street Address City State ZIP Code
Practice TIN/EIN*
Number of Dentists at the Practice*
Dentist Name*
First Last
Dentist NPI Number*
Phone*
Email*
Office Manager*
Phone
Email
How did you hear about us?*
Referred By:*
Terms & Conditions*
- Accept Terms and Conditions

Office Manager Membership

Exclusively for Office Managers

Office Manager Membership

Perfect for Dental Office Managers and Administrators!

View Membership Benefits

Office Manager Membership Form

Name*
First Last
Address*
Street Address City State ZIP Code
Phone*
Email*
Practice Name*
Address*
Street Address Address Line 2 City State ZIP Code
Number of Dentists at the Practice*
How did you hear about us?*
Referred By:*
Terms & Conditions*
- Accept Terms and Conditions

Dental Student Membership

Exclusively for Dental Students

Dental Student Membership

Perfect for currently enrolled Dental Students!

View Membership Benefits

Step 1 of 6

16%

What is your intended specialty?*
Do you intend to do a residency or internship?*
- Yes
- No

Where do you plan to practice?*
Do you need help finding your first job?*
- Yes
- No

When you graduate, your first job will be:*
- Associate in a corporate practice
- Associate in an independent practice
- Hang your own shingle

What is the name of the dental school you are/will be attending?*
What month and year will you graduate?*

What are your practice priorities? (click all that apply)*
- None of these
- Pay-off student debt
- Establish Independent Practice - Immediately
- Establish Independent Practice - within 2 years
- Establish Independent Practice - within 5 years
- Establish Independent Practice - within 10 years
- Practice in a Rural Community
- Practice in an Urban Community

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Personal Email Address*
Phone*
Gender*

The Dental Advocacy Group is a member-based dental organization formed to enhance the quality of time and services from dentist to patient by pre-negotiating non-clinical business functions that would otherwise occupy time better utilized for clinical care.

Step 1 of 11

9%

What is your practice specialty?*
- General Dentist
- Endodontist
- Oral Surgeon
- Orthodontist
- Pediatric Dentist
- Periodontist
- Prosthodontist
Where is your practice located?*
What is your practice zip code?*

How many dentists are in your practice?*
- 1
- 2-4
- 5+
How many locations?*
- 1
- 2
- 3
- 4+

When was your practice UCR last increased:*
- within the last 12 months
- within the last 24 months
- more than 24 months ago

What is the estimated Gross Annual Revenue for your practice?*
- $250k to $499K
- $500k to $749K
- $750k to $1.24M
- $1.25M to $2.9M
- $3M-$5M
- $5M +

What percentage of revenue comes from PPO's?*

The practice holds In-Network PPO contracts with: (check all that apply)*
- None of these
- Aetna
- Anthem
- Ameritas
- Assurant
- Blue Cross
- Cigna
- Companion Life
- Delta Dental
- Guardian
- Humana
- Medicare Advantage Plus
- MetLife
- Principal
- United Concordia
- United Healthcare

The practice holds In-Network Umbrella PPO contracts with: (check all that apply)*
- None of these
- Careington
- Connection Dental / GEHA
- Dentemax
- Diversified
- Maverest / Stratose / Zelis
- Premier

What practice management software do you use?*
- Dentrix
- Eaglesoft
- Open Dental
- Other
Do you offer health insurance to your employees?*
- Yes
- No

Who is your primary vendor for clinical supplies?*
- Atlanta Dental Supply
- Benco
- Goetze Dental
- Henry Schein
- Midwest Dental
- Nashville Dental
- Patterson
- Other

What are your practice goals in the next 12 months (check all that apply)*
- Reduce the amount of PPO write-offs
- Increase the profitablity of the practice
- Fill excess capacity
- Start-up practice intending to grow
- Add an associate dentist
- Add a new location
- Acquire an existing practice
- Begin accepting insurance

Please complete to receive your FREE Practice Analysis.
Practice Name*
NPI Number*
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Role*
- Owner/Dentist
- Associate Dentist
- Office Manager
- Other
Email*
Best Phone*
Best Contact Method*
Best days / times to call
How did you hear about us?*
Referred By:*

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Dental Advocacy Group
184 W. Franklin St
# 622
Hartwell, GA 30643-9998

Telephone: 770-727-5611

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