Matthew W. Baird, DDS
Nathan L. Horwitz, DDS, MS
Joshua C. Morrow, DMD, MS
Andrew D. Schweizer, DMD
William C. Grine, DMD, MS
Kevin P. Hagood, DDS, MSD
Colin P. Egan, DDS

OFFICE LOCATIONS:

GREENSBORO

HIGH POINT

ASHEBORO

KERNERSVILLE

WINSTON-SALEM

Introducing:

DOB:

Appointment Date:

Appt time:

Phone #:

FOR ENDODONTIC CONSIDERATION:

Tooth #(s):

Comments:

Referred by Dr.

Date:

Office:

Phone:

Patient will be instructed to return to referring dentist for final restorationSEE REVERSE FOR OFFICE LOCATION DETAILSIF UNABLE TO KEEP APPOINTMENT, WE REQUIRE 24 HOURS NOTICE

OFFICE LOCATIONS:

GREENSBORO

1602 Benjamin Parkway, Suite A
Greensboro, NC 27408
Phone: 336-288-0010 Fax: 336-282-5754
Email: staff@piedmontendo.com

HIGH POINT

1313 Eastchester Drive
High Point, NC 27265
Phone: 336-889-5656 Fax: 336-889-5681
Email: hpstaff@piedmontendo.com

ASHEBORO

350 North Cox Street, Suite 21
Asheboro, NC 27203
Phone: 336-629-1444 Fax: 336-629-4045
Email: asheborostaff@piedmontendo.com

KERNERSVILLE

222 Broad Street
Kernersville, NC 27284
Phone: 336-423-5075 Fax: 336-423-5072
Email: kvillestaff@piedmontendo.com

WINSTON-SALEM

1673 Westbrook Plaza Drive, Suite 220
Winston-Salem, NC 27103
Phone: 336-365-2246
Email: wsstaff@piedmontendo.com

SCAN HERE or visit
www.piedmontendo.com
for more information