Access to Baby and Child Dentistry (ABCD)
On-Line Enrollment

Phone: (509)324-1478
Fax: (509)324-3614

* Marked fields are required.

Parent's First Name: *
Parent's Last Name: *
Address: *
City: *
State: *
Zip Code: * (99999 or 99999-9999)
Phone: * ((999)999-9999)
Email Address: *
Child's First Name: *
Child's Last Name: *
Child's Birthdate: *
Provider One #: *