Call: (310) 273-2223

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone or complete the appointment request form below.  Our scheduling coordinator will contact you to confirm your appointment.

Please do not use this form to cancel or change an existing appointment.


*Items in bold are required.
Name:  
Address:
City:
State/Province:
Zip/Postal:
Email:
Phone:  
Are you a current patient?
Best time(s) to call?
Preferred day(s) of the week for an appointment?
Preferred time(s) for an appointment?
Please describe the nature of your appointment (e.g., consultation, check-up, etc.):
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In addition, if you have PPO insurance, we can verify it for you as a courtesy to you. To do so, please provide the following information within the the box above:

1. Name of your insurance company.

2. Subscribers name and date of birth (If different than patient).

3. Subscribers ID #

4. Name of Employer if insurance is through employment.