Six Month Smiles - Braces & Aligners Essentials Course - Dallas, TX
March 17-18, 2023 @ 6MS Headquarters
6270 Morning Star Drive, Suite 120
The Colony, TX 75056
Presented by: Dr. Fabiana Ertumen
Base Course Price - Doctor: $1,499.00 | Team: $325.00

Your Information * Required

First Name *

Please provide your First Name.

Looks good!

Your Last Name *

Please provide your Last Name.

Looks good!

Are you a Dentist? *

Yes

Dental License Number

Please provide Dentist License Number.

Looks good!

How did you hear about this course? *

Practice Name *

Please provide Practice Name.

Looks good!

Practice Phone *

Please provide Phone number.

Looks good!

Mobile Number*

Please provide the doctor's Mobile number.

Looks good!

Email *

Please provide Email address.

Looks good!

Confirm Email *

Please confirm the Email address.

Looks good!

Address *

Address (Line2)

City / Town *

2 character State (XX)*

Postal Code *

Country *