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PERIO FOUNDATIONS (LEVEL 1)
*if you would like to have an invoice for your dental clinic and not paying Vat, VIES registration is needed
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First Name *
Second Name *
Date of Birth *
MM
/
DD
/
YYYY
Email *
Mobile Number *
Gender *
Address *
City *
State *
Country *
Fiscal Code *
Vat Number (tax id/ C.I.F/ NIP)
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