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Update your email and mailing address
The WDA is updating email and mailing addresses. The letter you received lists the addresses the WDA has on file for you. Please update your contact information below:
*
1.
Business contact information
(Required.)
First name
Last name
Email address
Street Address
City
State
ZIP
Name of company
Owner, employee dentist or other
*
2.
Home/personal contact information
(Required.)
Email address
Street address
City
State
ZIP
Cell phone number
3.
Preferred email address?
Home
Business
4.
Preferred mailing address?
Home
Business
5.
Do you want to receive text updates from WDA?
Yes
No
6.
Additional comments for the WDA
