Patient Info Forms & Insurance Accepted

2337 E Bonanza Road, Las Vegas, NV 89101

Tel: (702) 749-4321

Fax: (702) 749-4459



For Referral Doctor Office & Patients

(we welcome following list of DMO, PPO, Culinary, Unions, dental plans)

For Patients

First visit

For your convenience, you may complete our online patient registration form Please print this form, fill it out, and bring it with you to your first appointment at our office. Please provide us with the following information at your initial appointment:

  • Your referral slip and any x-rays if applicable

  • Your dental / medical insurance information

  • A list of medications/dosage you are presently taking

  • A list of allergies to any medications or latex.

Your initial appointment will consist of a consultation explaining your diagnosis and treatment options. If treatment has been deemed necessary by your general dentist in advance, treatment can be done the same day as the consultation.

Please alert our office if you have a medical condition that may be of a concern prior to your appointment. (i.e. artificial heart valves, joint replacements or heart conditions that require premedication by antibiotics.) IMPORTANT: A parent or guardian must accompany all patients under 18.

HIPAA Privacy Policy

The Notice of Privacy Practices, presents the information that federal and applicable state law requires us to give our patients regarding our privacy practices.

Please click here for a copy of our HIPPA privacy policy

For Referral Doctor Office

Please click to download our referral form for your patient care

*** Same day emergency appointment is available upon your request ***

Patient will be instructed to return to referral dentist for restorative treatment

Upon completion of consultation and/or treatment, a doctor report will be sent to your office

*** If you have any questions regarding your insurance, please give us a call at (702) 749-4321 or email us at staff will strive our best effort to help your office and your patients.

For Patients

Financial Policy

Our staff will inform and explain the fees involved with the expected treatment. For patients with dental insurance, "pre-treatment estimate" of your responsibility and covered benefits from from your insurance coverage will be provided. We will gladly assist you in filing your insurance claim. However, any insurance claim denied or remaining unpaid after 30 days will automatically become your responsibility.

For your convenience, we accept Debit / ATM cards, Visa, MasterCard, Discover, American Express,and cash. We deliver the finest care at the most reasonable cost to our patients; therefore, payment is due at the time service is rendered.

CareCredit for dental procedures

We're pleased to offer our patients the CareCredit® card, North America's leading patient payment program. CareCredit (third party company) lets you begin your treatment immediately — then pay for it over time with low monthly payments that fit easily into your monthly budget. Now you don't have to save up for years to finally get the smile you've always wanted.

CareCredit is the credit card exclusively for healthcare services. CareCredit offers low monthly payment plans for healthcare procedures not commonly covered by insurance, including dental treatments. Plus, you can use your CareCredit card for other dental treatments.

Learn more by visiting or contacting our office. Apply online for your CareCredit card today!

If do not have not Adobe Reader, please click here to download and install the software.

Frequently Ask Questions (FAQ) with Answers

Please click here for FAQ with Answers to better help us to address any concerns in advance.

Patient Comments

Please click here for patient testimonials

2337 E Bonanza Road, Las Vegas, NV 89101

Tel: (702) 749-4321

Fax: (702) 749-4459