Doctor Referrals


First Name:*
Last Name:*
Phone:*
Patient DOB:
Patient Email:
Referred By:*
Office:*
Consultation:
Other Consultation:
Implants:
Surgical Template:
Provisional:
Additional Notes:
Please enter the text you see:
806-686-4366
6123 79th Ave, Lubbock, TX 79424

Office Hours:
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:
Sunday:
10am–7pm
8am–5pm
7am–3pm
8am–5pm
7am–2pm
By appt only
Closed


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