Practice Information Form

1

Practice Information

Basic details about your dental practice. Fields highlighted in green were found automatically — please verify they're correct.

Practice Name

Website URL

Phone Number

Email Address

Street Address

City

State

ZIP Code

Office Hours

Enter your regular hours. Leave blank for days you're closed.

2

Doctor / Provider Information

This information is used to build your authority profile, which helps Google understand your credentials.

Full Name (with title)

Job Title / Specialty

Dental School

Graduation Year

NPI Number Auto-found

National Provider Identifier — we looked this up for you. Please verify it's correct.

State License Number Auto-found

3

Professional Memberships

Check all organizations you belong to. These are shown to Google as proof of your expertise.

American Dental Association (ADA) Academy of General Dentistry (AGD) American Academy of Cosmetic Dentistry (AACD) American Academy of Implant Dentistry (AAID) International Congress of Oral Implantologists (ICOI) American Association of Orthodontists (AAO) American Academy of Pediatric Dentistry (AAPD)

State / Local Dental Associations

Other Memberships

Certifications & Training

Invisalign Certified Clear Aligner Certified IV Sedation Certified Oral Conscious Sedation Implant Placement Training Laser Dentistry Certified Cosmetic Dentistry Fellowship CBCT / 3D Imaging Certified

Other Certifications / Training

4

Online Profiles & Directories

These links help Google verify your identity across the web. Paste the full URL for each profile you have.

Don't have some of these profiles? That's OK — we recommend creating them. See our Ranking Quick Wins guide for step-by-step instructions.

Google Business Profile URL

Go to Google Maps, find your practice, click "Share", copy the link

Healthgrades URL

Search healthgrades.com for your name

LinkedIn URL

Zocdoc URL

Yelp URL

Facebook Page URL

Instagram URL

Other Directory URLs

5

Services Offered

Check all services your practice offers. We use this to build your service pages and schema markup.

Other Services

6

Additional Information

Google Analytics / Tag Manager ID

e.g., G-XXXXXXXXXX or GTM-XXXXXXX (check with your current web provider if unsure)

Anything else you'd like us to know?

Thank you!