Lebowitz Dental Associates

Call 602.264.2905
to schedule your appointment

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New Patient Form



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Billing information (if different than above)

Responsible Party

Insurance

*

Emergency Contact Info:

Financial Statement and Policy

Payment is expected as services are rendered.
We will gladly bill your dental insurance, however, patient portion is due at time of appointment.
We accept cash, check, Visa, MasterCard, Discover and American Express. If financing is needed
for extensive treatment please let us help you with participating finance companies before treatment
begins.




1277 East Missouri Avenue, Suite 205
Phoenix, AZ 85014
Phone: 602.264.2905

topdentistsphoenixmag2012

Top dentistry clinics in Phoenix 2016
Dr. Michael B. Lebowitz, DDS has been recognized as one of the top Phoenix Dentistry practices.
Verified by Opencare.com