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Request A "Current Patient" Appointment

To request an appointment for our current patients, contact us by calling 310-443-9596 or by completing the following form so that we can contact you to schedule an appoinment.

For EMERGENCY CARE, please call 310-443-9596
(DO NOT USE THIS FORM FOR ANY EMERGENCIES)

Child's First Name

Child's Last Name

Parent's First Name

Parent's Last Name

E-mail

Best Phone # To Reach You

Best Time To Contact You

Purpose of Appointment

Preferred Day(s)

Mon

Tues

Wed

Thurs

Preferred Time

Promo. Code
(if any)

If you have any questions or comments, please type it below:

THANK YOU!

Dr. Payman Pirnazar D.D.S, M.S., Inc.
BabyTeeth Children's Dentistry
10921 Wilshire Blvd., Suite 1103
Los Angeles, CA 90024

Telephone: 310-443-9596
Website: BabyTeeth.com

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