Dental Referral

Introducing *

Date of Birth

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Parent/Guardian (if minor) *

Phone

Referring Doctor *

How can we help?

phone: 605.335.6680
fax: 605.335.8342 • 1.866.633.6202

We also see patients in our Luverne and Freeman satellite offices.

Luverne Dental Center

115 East Main
Luverne, MN 56156

Freeman Dental Clinic

1008 Industrial Road
Freeman, SD 57029