Dr. Harmik Derhartounian Professional Dental Care Referrals in Monterey Park Sedation

Monterey Park California Pacific Dental Group Sedation Dentist

2016 S Atlantic Blvd
Monterey Park CA 91754
Tel. (888) 642-2763

6801 Lankershim Blvd
North Hollywood CA 91605
Tel. (818) 764-0718

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Pacific Dental Group
A Division of Derhartounian Dental Corporation

Please use the form below to enter the pertinent information regarding your professional referral to our practice.

Patient's Title:

Patient's First Name:

Patient's Last Name:

Referred By:

Telephone:

Tooth #s:

Please include digital radiograph by pressing the browse button and locating the image on your hard drive:

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Dentist
In Monterey Park California and the surrounding
Los Angeles - Montebello - Alhambra - North Hollywood CA areas.

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