Dental Clinic in North Hollywood CA | Cosmetic Dentist Offices

Appointment Information

Location

Preferred date

Preferred time

Morning Afternoon

Type of appointment

Other

Are you having a dental emergency?

Yes No

Next Step >

In order to save time and have everything ready for you, please provide us with your insurance information.

Do you have Dental insurance

Yes No

Insurance Information

Insurance Name

If you are the Subscriber:

Name of Insured

Insured Soc. Sec

Or ID Number

Employer's Name

Group ID

Patient is

Policy Holder Responsible Party

Responsible Party (if someone other than the patient)

Resp/Party

Birth Date *

Address: *

City *

Phone

2ndPhone

Contact method

Phone Email

Email

Relationship to Insured

Other

Next Step >

Any necessary information to verify coverage of benefits will be confirmed on follow-up call. No insurance? No problem! Aava Dental can help you whether you have insurance or not.

Referred by

Additional information

(844)766-7422

855-228-2336

Patient Information

Appointment Information

Insurance Information

Aava Dental of North Hollywood

Dental services provided at North Hollywood

- General Dentistry

- Cosmetic Dentistry

- Specialty Dentistry

Make an appointment

Patient Information

Appointment Information

Insurance Information

Aava Dental of North Hollywood

Dental services provided at North Hollywood

- General Dentistry

- Cosmetic Dentistry

- Specialty Dentistry