DDMC Dental Order Sheet

(562) 484-1318 | dmc@dentisusa.com

14747 Artesia Blvd, Suite 5A, La Mirada, CA 90638

For IOS Submission
iTero, Medit, Cerec, and 3Shape are digital submitted.
For Conventional Submission
Please fill out the form below.
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Download Blank Order Form

You can download the blank PDF form if you prefer to fill it out manually.

Required Information

Teeth Number

      Delivery Date & Options

      IMPLANT & ZIRCONIA / ALL CERAMIC

      ZIRCONIA / ALL CERAMIC

      SHADE

      CUSTOM IMPLANT ABUTMENT

      PONTIC DESIGN (Check Box)

      Pontic Design 1
      Pontic Design 2
      Pontic Design 3
      Pontic Design 4

      Design

      ABUTMENT EMERGENCE PROFILE

      Full Anatomical
      Contour Soft Tissue
      No Tissue Displacement

      RX Specific Instruction

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