Referral Form (PCOMS)

Address:
Dallas
6140 Sherry Lane
Dallas, TX 75225

Phone:
(214) 363-2475

Hours:
Mon–Thu: 9:00 AM–4:00 PM
Fri: 8:00 AM–12:00 PM

Contact Us

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Does the patient require antibiotics prior to dental treatment

Extraction

Alveoloplasty

TMJ

Implants

Being Mailed

Biopsy

Incision and Drainage

Orthognathic Evaluation

PreProsthetic

Please Take

Given to Patient

Lesion Evaluation

Exposure

Cosmetic

Cleft Lip and Palate

No XRay

Hard Tissue

Infection

Ridge Augmentation

OralFacial Lesion

Expose and Bond

Soft Tissue

Bone Grafting

Other

Frenectomy

Apicoectomy

Permanent Tooth

Deciduous Tooth

disregard this

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