Dental History

How do you feel about dental treatment?
Have you seen a dentist before?(Required)
Are you happy with the appearance of your teeth?
Would you like your teeth to be whiter?
Would you like your teeth to be straighter?
Do you have, or have you ever had any of the following dental conditions? Please check all that apply.
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By providing a mobile number, I agree that Newport Beach Dental Center may send me automated appointment and dental marketing messages at the number I provided above. I understand my consent is not required for purchase.
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1441 Avocado Ave, Ste 606 Newport Beach, CA 92660

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