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Call us today for help!  (757) 873-3001

City Center Dental Care

Implant Dentist | Invisalign | Sedation Dentist | Children Dentist

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  • Our Services
    • Cosmetic Dentistry
    • Dental Implants
    • Invisalign
    • Sedation Dentistry
    • Sleep Apnea
    • TMJ Treatment
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  • About Us
    • Meet Your Doctors
    • Meet the Hygiene Staff
    • Meet the Clinical Staff
    • Meet the Office Staff
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    • Testimonials
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  • New Patients
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  • Home
  • Our Services
    • Cosmetic Dentistry
    • Dental Implants
    • Invisalign
    • Sedation Dentistry
    • Sleep Apnea
    • TMJ Treatment
    • Teeth Whitening
  • About Us
    • Meet Your Doctors
    • Meet the Hygiene Staff
    • Meet the Clinical Staff
    • Meet the Office Staff
  • Contact Us
    • Testimonials
    • Smile Gallery
  • New Patients
  • Current Patients
    • Pay Your Bill
  • Appointment
Dental-Services-near-me

New Patients

Please complete this form before your first visit.

  • Patient Information

  • Date Format: MM slash DD slash YYYY
  • Emergency Contact

  • Health Information

  • Are you taking, or have you taken:
  • To the best of my knowledge, all of the preceding answers and information provided are true and correct. If I, or a patient I
    am responsible for, ever have any health changes, I will inform the staff at the next appointment without fail.
  • Spouse or Responsible Party Information

  • Employment Information

  • Dental Benefits Information

    Primary


  • Secondary

    Due to the unpredictable coverage of secondary dental benefits, we do not file or estimate these benefits. We will assist you with the necessary paperwork to file secondary benefits.
  • I am aware that fees for dental services, which include unpaid balances, deductibles and co-payments, are due at
    the time of service unless other arrangements are made in advance.
    If I have dental benefits, I am aware that as a courtesy to me, this office will prepare forms and submit necessary
    documents to my benefit company. However, I realize that my benefit policy is a contract between me, my employer and the
    benefit company, and that I, not my benefit company, am ultimately financially responsible for all charges for treatment
    rendered. If my dental benefit company does not pay within 60 days, I agree to accept responsibility for any unpaid balance.
    I realize that accounts which are not paid within 30 days after being billed are subject to a 1% per month (12% per
    annum) finance charge on the unpaid balance. Overdue or unpaid accounts may be turned over to a collection agency, and I will be responsible for all of the costs of collection, including court costs, collection agency fees and attorney fees.
    I understand the above policies and accept responsibility for myself or patient:
  • Referral Information

  • This field is for validation purposes and should be left unchanged.

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City Center Dental Care

Address: 709 Mobjack Place, Newport News, VA 23606
Phone: 757.873.3001
Email: [email protected]

Hours of Business:
Monday, Wednesday, Friday: 8am – 5pm
Tuesday, Thursday: 8am – 5:30pm

About Us

City-Center-Dental-Care-Team
We are located about two blocks from the Cinemark City Center 12 theaters. Mobjack Place intersects Thimble Shoals Blvd. across from the Fountain Way Parking Garage. Our office is also within walking distance of many shops and restaurants.

Dental Care

  • Cosmetic Dentistry
  • Dental Implants
  • Invisalign
  • Sedation Dentistry
  • Sleep Apnea
  • Teeth Whitening
  • TMJ Treatment

  • Home
  • Our Services
  • About Us
  • Contact Us
  • New Patients
  • Current Patients
  • Appointment

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