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DoseSpot Registration

DoseSpot Registration Form


Provider Info
First Name


Last Name


Phone #


Email


DEA #


Personal NPI #


Birthdate


Office Name


Register for EPCS?




Name of person submitting form
Clinic Info
Clinic/Practice Name


Address


City


State


Zip Code


Phone #


Fax #


Practice Administrator* (First and Last)

Practice Administrator Email


ADSO Member or 75+ Providers?


list all non-providers (proxy clinicians) who will access DoseSpot and their email addresses (required if using stand-alone)

*Designate a staff member (typically an office manager) who will be the point of contact and own the DoseSpot sign up process for providers and proxy clinicians. This person will need admin permissions in Open Dental and must be a non-provider. To register additional proxy (non-provider) users please send an email with their first and last names to erx@opendental.com.



Open Dental Software 1-503-363-5432