Dr. Marina Alvarez-Pettengill, DDS
 | From Route 95 Take Route 495 North to Exit 14B North Attleboro. Take left at the first light on Route 152/Taunton Street. Our office is about five buildings down on your right. |
| From Route 1 North Take right at Route 152/Taunton Street (Boston Tropical Tree.) Our office is about five buildings down on your right. |
| From Route 1 South Take a left on Route 152/Taunton Street (Plainville Racetrack and Boston Tropical Tree.) Our office is about five buildings down on your right. |
| From Attleboro Take Route 152/Taunton Street North into Plainville. Our office is about one-half mile down on your left. |
| From Mansfield Take 106 East to Route 152/Taunton Street North. Turn right on Route 152/Taunton Street North. Our office is about one-half mile down on your left. |
| Take the elevator to the first floor or the outside stairs to the middle level. |
| Please call for additional directions. |
Initial Registration Form
Name: ______________________________________________________
Last Name, First Name, Middle Initial
Birth Date: _____________ Age: ______ SS#: _______-______-________
Reason for Appointment
Routine
Cleaning & Checkup___ Referral___ Cavities___
Toothache___
Cosmetic___ Bleeding Gums___
Emergency
Emergency Toothache ___ Duration of Pain ________
Facial Swelling? ____
Keeps You up at Night? ___ Broken Tooth? _____
Front: _____ Back: _____
Last Cleaning: _________ Last X Rays: ________
Last Dental Appointment: ___________
Do you have dental insurance?_____ If you do, complete insurance information below.
Payment by: Check ___ Credit Card ____ Cash ______
Interested in Financing? ____
Primary Dental Insurance_________________
Card # _________________
Secondary Dental Insurance_________________
Card # _________________
Visit Our Convenient Location Today!
maps.expedia.com
Home | About Us | More Info | Practice
© Copyright 2000, Verizon
|
Phone: 508-699-2221 Fax: 508-699-2910 Hours: Address: 74 Taunton Street Suite 101 Plainville, MA 02762 (We are located in the Shepardville Professional Park on Route 152, near Route 1 and I-495 in Plainville) |