Dentistry for Children & Adolescents

Doctor Referral

Centennial Lakes Medical Center
7373 France Avenue South
Suite 402
Edina, MN 55435
(952) 831-4400
Fax: (952) 893-3041
Ridge Point Medical Building
14050 Nicollet Avenue South
Suite 100
Burnsville, MN 55337
(952) 435-4102
Fax: (952) 435-8925
Children's West Prof. Office Building
6060 Clearwater Drive
Suite 210
Minnetonka, MN 55343
(952) 932-0920
Fax: (952) 932-0929

In an effort to provide the best service possible, we ask you to fill this form as completely as possible. Thank you for your cooperation.


Please select the office to submit the form:
May we call with questions?
May we call the patient to schedule an appointment?
Are X-rays available?

The information that I have given above is correct to the best of my knowledge.


Please enter the verification codes listed below to continue with submitting your form.