Create An Account

1

Responsible Party

2

3

Responsible Party Information

Please enter the name, mobile and address for the responsible party that will be billed for this account.

First name

Middle initial optional

Last name

Account holder’s email address

Mobile Phone

Address

Suite/apt no

Address 2

City

State

ZIP code

Include responsible party as a member

After creating your account, you'll receive an email to set your password.

Tooth Tales Sparky

Location

12741 Miramar Pkwy, Ste 203

Miramar, FL 33027

Phone

954-236-5273

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