1736 Dickerson Boulevard
Suites C and D Monroe, N.C. 28110

(704) 225-8555

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    ​Piedmont Family Dentistry

    1736 Dickerson Boulevard

    Suites C and D Monroe, N.C. 28110

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    Now in our 15th Year!

    New Patient?

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    online with Piedmont Family Dentistry

    Copyright © 2015 Piedmont Family Dentistry 

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    If you feel uncomfortable providing any of this information over the internet you can always give us a call at (704) 225-8555 during the hours listed below.

     

    • Monday – Thursday from 8 a.m. – 5 p.m

    • Friday from 8:30 a.m. – 1 p.m

    • Saturday Restricted to established patients, and limited to hygiene (cleaning) visits. Please call the office during normal business hours to schedule.

     

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    News & Announcements

    It’s that time of year again- Maximize your dental insurance!

    Posted on: October 2nd, 2014

     

    Your dental insurance premium is pulled out of every hard-earned paycheck. But come the New Year, any unused benefits are gone-- and on top of that, there's that new deduc...

    No Insurance? No Problem? Introducing Piedmont Family Dentistry’s Dental Discount Plan!

    Posted on: January 6th, 2014

     

    We're excited to announce a new program for patients who do not  have dental insurance: Piedmont Family Dentistry's Dental Discount Program!...

    Its That Time Of Year Again: Maximize Your Dental Insurance!

    Posted on: October 29th, 2013

     

    Your dental insurance premium is pulled out of every hard-earned paycheck. But come the New Year, any unused benefits are gone-- and on top of that, there's that new deductible that has to be met. ...

    New Patient Documents

    Dental History Questionnaire (PDF 36 KB)
    Dental History Questionnaire (PDF 36 KB)
    Medical History Form (PDF 1.08 MB)
    Medical History Form (PDF 1.08 MB)
    New Patient Registration Form (PDF 96 KB)
    New Patient Registration Form (PDF 96 KB)
    Appointment/Financial Policy Form (PDF 40 KB)
    Appointment/Financial Policy Form (PDF 40 KB)
    Communication Consent Form (PDF 40 KB)
    Communication Consent Form (PDF 40 KB)
    HIPPA Acknowledgement Form (PDF 20 KB)
    HIPPA Acknowledgement Form (PDF 20 KB)
    HIPPA Privacy Notice Form (PDF 40 KB)
    HIPPA Privacy Notice Form (PDF 40 KB)
    All Piedmont Dental Forms (PDF 280 KB)
    All Piedmont Dental Forms (PDF 280 KB)