FORM AND INSTRUCTION FOR PATIENTS:
PATIENT: ORAL SURGERY INSTRUCTIONS
Oral Surgery Post Operative Instructions - Advanced Dental Scarsdale
Instrucciones Para Despues de una Extraccion Dental (DEBE/NO DEBE)
Oral Surgery DO'S and DONT'S - Advanced Dental Scarsdale
Oral Surgery: Care After Bone Grafting
Oral Surgery: Care After Dental Implant
FOR OFFICE USE ONLY: PEDIATRIC DENTIST FORMS
Welcome package Pediatric Dentist
PATIENT: ORTHODONTICS/BRACES INSTRUCTIONS
Instructions for Orthodontic opatients (Life with Braces) - Scarsdale Advanced Dental
Preventing problems with your braces - Scarsdale Advanced Dental
FOR OFFICE USE ONLY : ORTHODONTIC FORMS
Welcome Advanced Dental Orthodontic
Ortho adjustment/repair TX form
Informed Consent Orthodontics Patient - Advanced Dental
Release of Liability Early Removal of Orthodontic Appliances
Informed Consent Braces Removal and Retainer Consent Form
Warning letter due to non-compliance (ortho)
Ortho dental clearance (continue TX)
Transfer Patient in-Active Treatment ortho
Healthplex Orthodontic HLD Form
Denta Quest Orthodontic HLD Form
Payment arrangement 12 months comprehensive orthodontic treatment
Payment arrangement 24 months comprehensive orthodontic treatment
Payment arrangement orthodontic treatment government
Payment consent Delta Dental/32BJ ortho 2018
Payment consent GHI/1199/Emblem 2019
Payment consent Insurance-Private 2019
FOR OFFICE USE ONLY: ORAL SURGERY FORMS
Welcome package Oral Surgery Procedures
Welcome Oral Surgery CONSULTATION
Welcome Oral Surgery Scarsdale
Advanced Dental Surgery "Tx" Form
Informed Consent Form for Oral and Maxillofacial Surgery and Anesthesia
FOR OFFICE USE ONLY : ENDODONTIC FORMS
Informed Consent for Endodontic Treatment
Disclosure sheet for cosmetic or uncovered treatment
FOR OFFICE USE ONLY: OTHER FORMS
Financial Policy Advanced Dental 2018
Notice of privacy practices Advanced Dental
Disclosure sheet for cosmetic or uncovered treatment
HIPAA form for release health information
FOR OFFICE USE ONLY: INFORMED CONSENT FORMS
Informed Consent Form nitrous oxide sedation
Informed Consent Form crown and bridge prosthetics
Informed Consent Braces Removal and Retainer Consent Form
Release of Liability Early Removal of Orthodontic Appliances
Disclosure sheet for cosmetic or uncovered treatment
FEE SCHEDULE
Aetna dental PPO plans fee schedule
Denta Quest Fidelis Exchange | Affinity Exchange | Healthfirst Exchange
DC37 fee schedule for ortho, pedo, endo 2018
Liberty dental plan New York Medicaid CHIP
INSURANCE PHONE NUMBERS
| Denta Quest | 800-341-8478 | www.govservices.dentaquest.com |
| Denta Quest HIP | www.provider.dentaquest.com/providerlogin | |
| Healthplex | 888-468-2183 Fax: 516-542-2614 |
www.healthplex.com/provider |
HIP Carrington |
800-477-8255 | |
| Liberty Dental Plan | 888-352-7924 | www.libertydentalplan.com |
| Medicaid | 800-343-9000 | www.emedny.org/epaces/Login.aspx |
| AETNA | 800-451-7715 | www.aetna.com/provweb/index.html |
| BCBS | 800-722-8879 | |
| BCBS federal | 800-522-5566 | |
| Cigna | 800-342-5234 | www.cignaforhcp.cigna.com |
| Daniel H Cook | (212) 505-5050 Fax: (212) 7141455 |
www.dhclaims.com |
| DC37 | 212-815-1600 | www.inmediata.com/us/index.php |
| Delta Dental | 800-932-0783 | www.deltadentalins.com |
DeltaDental Mass |
617-886-1234 |
|
| Delta Dental Virginia | 800-237-6060 | |
| DDS (MagnaCare) | 800-255-5681 | |
| Dental Shop | 888-683-3682 | |
| Guardian | 800-541-7846 | www.guardiananytime.com |
| GHI Emblem Health (1199) | 646-473-7160 212-501-4444 |
www.emblemhealth.com |
| Local 371 | 212-777-9000 (ext. 3069, 3059, 3070) Fax: 212-260-7908 |
|
| Local 1180 | 212-505-5050 | |
| Loclal 94 (Seledent) | 800-520-3368 | |
| MetLife | 800-275-4638 | www.metdental.com/prov/execute/home |
| PBA | 212-349-7560 | |
| United Concordia | www.unitedconcordia.com | |
| Seledent | 516-887-7566 | |
| SIDS | 718-204-7172 | www.asonet.com/dentist.aspx |
| UFT | 800-577-0576 | |
United Health Care (Community plan) |
www.pwp.sciondental.com/PWP/Landing | |
| UHC |
877-816-3596 |