Catskill Dental Care – Free Cosmetic Dentist Smile Analysis in the Catskill NY area.

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Catskill Dental Care

Catskill Dental Care

Call (518) 943-0920

Smile Analysis

If you are 18 years old or older, we would be pleased to provide you with a smile analysis.

Please provide us with the following information and a member of our staff will contact you soon to schedule an appointment.

Smile Analysis Questionnaire

*First name:

*Last name:

*Phone:

*Email:

*ZIP/Postal Code:

How many teeth show in your smile?

Are you happy with your smile?

Yes No

Describe the color of your teeth:

very white
off white
yellow
dark yellow
grey

Are your teeth evenly colored?

Yes No

Are there any defects on your front teeth?

Yes No

Any fillings or crowns showing?

Yes No

Are your teeth crowded?

Yes No

Do you have spaces or gaps between your teeth?

Yes No

How many?

Do your gums show when you smile?

Yes No

Do you like the amount of gums that show when you smile?

Yes No

Further comments about your smile:

Call for an appointment:
(518) 943-0920

Make an Appointment

Catskill Dental Care

Practice Photo

Dr. Joseph M. Pilatich III

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Catskill Dental Care

132 Jefferson Heights
Catskill, NY 12414

General Info: (518) 943-0920

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Call Now To Schedule an Appointment: (518) 943-0920

Call Now! (518) 943-0920

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Catskill Dental Care, 132 Jefferson Heights, Catskill, New York 12414 - (518) 943-0920
Dr. Joseph M. Pilatich III

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