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(800) 931-1554
daniel@digitaldentalfusion.com
6280 S. Valley View Blvd., Las Vegas

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Fill out the form to send your case in electronically and send it in, along with any photos or models to:

Digital Dental Fusion
6280 S. Valley View Blvd., Suite 310
Las Vegas, NV 89118

(800) 931-1554

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FIXED SOLUTIONS:
ZIRPEEK®

Upper Lower PMMA Try In Final

FIXED SOLUTIONS:
POLYPEEK™®

Upper Lower PMMA Try In Final

FIXED SOLUTIONS:
ZIRTIBAR™®

Upper Lower PMMA Try In Final

REMOVABLE RESTORATIONS

DigiSmile® Dentures DigiSmile® Partials Upper Lower

ZIMO® CROWNS/BRIDGES

Zimo® Full Zirconia Zimo® + PFZ Zimo® + Veneer Zimo® Custom Abutment Zimo® Implant Screw Retained PMMA Try In

SHADE #

GUM SHADE

ENCLOUSURES

Photo(s) Model Impression Bite

Rx

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Checking this box and submitting this form is recognized as an electronic consent that you are acknowledging all the information is accurate and Digital Dental Fusion will begin the case.

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6280 S Valley View Blvd.
Suite 310
Las Vegas, NV 89118

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