If you are using a screen reader and are having problems using this website, please call 908-288-7240 for assistance.
Find a Dentist
×
Search By Practice Type
Practice Area:
Select an area of practice:
Endodontics
General Dentistry
Oral / Maxillofacial Surgery
Orthodontics
Pediatric Dentistry
Periodontics
Prosthodontics
County:
Select a county:
Branch
Calhoun
Genesee
Grand Traverse
Ingham
Jackson
Kalamazoo
Kent
Livingston
Macomb
Monroe
Montcalm
Oakland
Ottawa
Saginaw
St Clair
Washtenaw
Wayne
Please Select A Practice Area and County
Search By Name
Name:
Search
Please Enter A Name
Find a Doctor
×
Search By Practice Type
Practice Area:
Select an area of practice:
Allergy, Asthma & Immunology
Anesthesiology
Bariatric Medicine / Surgery
Breast Surgery
Cardio Thoracic Surgery
Cardiovascular Disease
Chiropractic Care
Colon & Rectal Surgery
Critical Care / Pulmonology
Dermatology
Ear Nose and Throat (Otolaryngology)
Endocrinology, Diabetes & Metabolism
Facial Plastic Surgery
Family Practice
Gastroenterology
General Surgery
Geriatric Medicine
Infectious Disease
Internal Medicine
Nephrology
Neurological Surgery (Brain & Spine)
Neurology
OB/Gyn
Oncology / Hematology
Ophthalmology
Orthopedic Surgery
Pain Management/P M & R
Pediatric Cardiology
Pediatric Endocrinology
Pediatric Infectious Disease
Pediatric Nephrology
Pediatric Neurology & Child Development
Pediatric Oncology / Hematology
Pediatric Orthopedic Surgery
Pediatric Pulmonology
Pediatric Surgery
Pediatrics
Physical Medicine / Physiatry
Plastic / Cosmetic Surgery
Podiatry
Psychiatry
Psychology
Radiation Oncology
Radiology
Reproductive Medicine
Rheumatology
Spinal Surgery
Sports Medicine
Urgent Care / Emergency Medicine
Urology
Vascular Surgery
County:
Select a county:
Branch
Calhoun
Genesee
Grand Traverse
Ingham
Jackson
Kalamazoo
Kent
Livingston
Macomb
Monroe
Montcalm
Oakland
Ottawa
Saginaw
St Clair
Washtenaw
Wayne
Please Select A Practice Area and County
Search By Name
Name:
Search
Please Enter A Name
Toggle navigation
Find a Doctor
Find a Dentist
Contact Us
Apply to be a MI Top Doctor
Apply to be a MI Top Doctor or MI Top Dentist
MI Top Doctor Submission
MI Top Dentist Submission
Step
1
of
5
20%
Contact Information
Practice Name
*
Doctor's Name
*
First
Last
Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Office Phone
*
Ext
Office Fax
*
Office Email
Doctor Email
*
Contact Person
*
First
Last
Contact Email
*
Best Contact Number
*
Best Contact Method
*
Phone
Email
Fax
Mail
Website
Number of Locations
Specialty/Specialties
*
Background Information
In your specialty are you?
*
Board Certified
Board Eligible
Neither
Length of years in practice
Any disciplinary actions against you or your practice within the last 10 years?
*
Yes
No
Please Provide Details
Please enter information about the incident(s) with dates and outcomes of these disciplinary actions
Up to date on all malpractice insurance?
*
Yes
No
Any malpractice claims within the last 10 years?
*
Yes
No
Please Provide Details
*
Please enter information about the incident(s) with dates and outcome.
Malpractice provider
*
Do you meet your Continuing Education requirements
*
Yes
No
Provide Details of your Continuing Education.
*
Education & Training
Medical School
*
Year of commencement
*
Residency Institution
*
Year of commencement
*
Please list any additional education &/or certification information you would like to include:
Appointments & Awards
Do you currently have any hospital appointments?
*
Yes
No
Please provide details below
Do you currently have any teaching appointments?
*
Yes
No
Please provide details below
Do you currently hold any administrative posts?
*
No
Yes
Please provide details below
Please provide a brief list of the major organizations you are a member
*
If you have any additional information you wish to share with the selection committee (publications, charitable works, research, technological advances in your practice, etc.) please detail below
Affirmation
By clicking below and submitting this application, I certify that all the information above is true to the best of my knowledge and held to be true. I also understand and agree that MI Top Docs (a division of USA Top Docs) may in their sole discretion, to approve or deny my application with or without cause. I understand and agree that MI Top Docs will conduct a background check (free of charge to myself) to review my license, malpractice, education, training, and employment. I also acknowledge that by providing my fax number and/or email addresses on this form I am giving USA Top Docs, permission to use this information in perpetuity and from time to time send marketing related information via fax and/or email. I also acknowledge an ongoing business relationship with USA Top Docs. I understand that my information will never be sold or distributed to anyone outside of USA Top Docs. If I wish to be removed from USA Top Docs (or its subsidiaries) communication, I must submit the request in writing to
[email protected]
, via fax to 908-288-7241 or via phone message by calling 908-288-7240 x 100 24/7/365. For this request to be valid (i) the request must clearly identify the fax number(s) to which this request relates too and (ii) the request must be communicated by one of the methods listed above.
Signed
*
Electronic Signature
By Checking This Box, I Am Signing This Application
Date
Month
Day
Year
Name
*
First
Last
Phone
This field is for validation purposes and should be left unchanged.
Δ
Step
1
of
4
25%
Contact Information (Required)
Practice Name
*
Dentist's Name
*
First
Last
Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Office Phone
*
Ext
Office Fax
*
Dentist Email
*
Office Email
Website
Number of Locations
Specialty/Specialties
*
Background Information
In your specialty are you?
Board Certified
Board Eligible
Neither
Length of years in practice
Any disciplinary actions against you or your practice within the last 10 years?
Yes
No
Any malpractice claims within the last 10 years?
Yes
No
Do you currently have any hospital appointments?
Yes
No
Education & Training
Dental School
Year of commencement
Residency Institution
Year of commencement
If you have any additional information you wish to share with the selection committee please include details below:
Affirmation (Required)
By clicking below and submitting this application, I certify that all the information above is true to the best of my knowledge and held to be true. I also understand and agree that MI Top Docs (a division of USA Top Docs) may in their sole discretion, to approve or deny my application with or without cause. I understand and agree that MI Top Docs will conduct a background check (free of charge to myself) to review my license, malpractice, education, training, and employment. I also acknowledge that by providing my fax number and/or email addresses on this form I am giving USA Top Docs, permission to use this information in perpetuity and from time to time send marketing related information via fax and/or email. I also acknowledge an ongoing business relationship with USA Top Docs. I understand that my information will never be sold or distributed to anyone outside of USA Top Docs. If I wish to be removed from USA Top Docs (or its subsidiaries) communication, I must submit the request in writing to
[email protected]
, via fax to 908-288-7241 or via phone message by calling 908-288-7240 x 100 24/7/365. For this request to be valid (i) the request must clearly identify the fax number(s) to which this request relates too and (ii) the request must be communicated by one of the methods listed above.
Signed
*
Electronic Signature
By Checking This Box, I Am Signing This Application
Date
Month
Day
Year
Name
*
First
Last
Untitled
Phone
This field is for validation purposes and should be left unchanged.
Δ