DDMC Order Sheet (East)

(914) 612-4844 | dmc.east@dentisusa.com

1335 Jericho Tpke, 2nd Fl New Hyde Park, NY, 11040

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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