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OTHER PROCEDURES
CONSULTATION
RADIOGRAPHS
Alveoplasty
Implants
Being Mailed
Given to Patient
Please Take
No X-Ray
E-Mailed
Biopsy
Orthognathic Evaluation
Incision and Drainage
Pre-Prosthetic
Lesion Evaluation
Cleft Lip and Palate
Exposure
Cosmetic
Hard Tissue
Other
Infection
IMPLANTS
Expose and Bond
Nobel Biocare
3i
ITI
TMI
Astra
Other
Soft Tissue
SURGICAL TEMPLATE
Frenectomy
Provided by Restorative Dentist
Provided by Surgeon
Please Verify Tooth #s:
COMMENTS
ORAL MAXILLOFACIAL
& IMPLANT SURGERY
5551 NORTH UNIVERSITY DR STE 203
CORAL SPRINGS, FL 33067
954.753.7070
