Call
(704) 365-4142
Patient Portal Login
Request Appointment
MENU
Dental Services
CEREC® Crowns
CEREC® | One Visit Crowns
Checkups & Cleaning
Dental Bonding
Dental Implants, Bridges, & Dentures
Fluoride Treatment
Gum Disease Evaluation
Nutrition Counseling
Porcelain & Minimal Prep Veneers
Teeth Whitening
Tooth Reshaping
Digital Dentistry
Invisalign®
SureSmile®
Our Practice
Meet Dr. Shah-Khan
Meet Our Staff
Our Office
Patient Resources
New Patients
Office Policy
Emergencies
Patient Forms
Financial Options
Contact Us
Request An Appointment
Appointment is for:
First Name
*
Last Name
Phone Number
*
Email
*
Date of Birth
Date of Birth
*
MM slash DD slash YYYY
Date of Appointment
Select up to 3 appointment dates in order of preference
Date 1
*
MM slash DD slash YYYY
Date 2
*
MM slash DD slash YYYY
Date 3
*
MM slash DD slash YYYY
Reason for Appointment
Select Reason
Select Reason
Checkups & Cleaning
Gum Disease Evalution
Fluoride Treatment
Notes for the Doctor
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.
