Pediatric Dentistry

Please send us your contact information and select an ideal appointment date. We will contact you to confirm an appointment (typically within 24 hours).

If you or your child is experiencing an emergency, please call us.

Pediatric Dentistry (804) 741-2226 • Orthodontics (804) 740-7281

Patient Name*
First Last
Patient Date of Birth
Date Format: MM slash DD slash YYYY
Parent / Guardian Name*
First Last
Email*
Phone*
Patient Status*
- New Patient
- Existing Patient
Visit Type*
- Pediatric Dentistry
- Orthodontics
Preferred Office Location
- Short Pump
- Mechanicsville
- Midlothian
- Gaskins Road (Pediatric Dentistry ONLY)
- Patterson Avenue (Orthodontics ONLY)
Reason For Visit
Date
Date Format: MM slash DD slash YYYY

Select an ideal date for your appointment. Availability is not guaranteed.
CAPTCHA
Dental Insurance*
Please list your Dental Insurance Provider, Group ID and Member ID. Please note if you do not have Dental Insurance coverage.

Had an amazing experience! My kiddos had even a better experience. Dr. Miller and her team were very pleasant, kind, educational and fun to work with!

More Kind Words