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Become a Founding Dental Provider

Tell us about your practice and how you would like to participate. This is an application to join — every submission is reviewed before any listing is published.

What happens after you submit

1. You enroll

Submit this form as an expression of interest.

2. We review

We review your details and licensing information.

3. You confirm

You confirm the listing details and terms.

4. We publish

Once approved, your listing appears in the directory.

Participation is free and voluntary. Submitting this form is an expression of interest and does not guarantee approval or a listing. Questions? See the Provider FAQ.

Public directory information. If approved, the fields in the sections marked “Shown publicly” (practice name, address, phone, website, services, and discount) may appear in the veteran-facing directory.

Practice Information

Shown publicly if approved

Practice Address

Shown publicly if approved

Services You Offer *

Shown publicly if approved

Select the services you’re willing to offer at a discount to veterans

Discount Details & Notes

Shown publicly if approved

Your Contact Details

Kept private — used only by our team to reach you, never published

Dental License

Kept private — used only to verify licensing, never published

Your submission will be reviewed before any listing is published.