Email Form/Supply Request

Please complete the form below and someone from our staff will contact you regarding your inquiry.


First Name *
Last Name *


Name of Practice
Position Title


Address
City
State
Zip Code


Email Address
Phone Number
Fax Number


Reason(s) for Contacting United Dental Labs:
 Not happy with current lab
 Seeking an additional lab for support
 New practice looking for lab
 Looking for innovative technologies
 Saw at tradeshow
 Saw ad in dental journals
 Received Direct Mail
 Found us online
 Referred to us
 Other

Comments
Please tell us about your practice and what you wish to accomplish with United Dental Labs.

* Indicates a required field.