704.861.1208
1725 South New Hope Road
Gastonia, North Carolina 28054

Request an Appointment

This online request form is to be used for non-urgent appointments. For medical emergencies, dial 911.

With this form, you are submitting a request for an appointment - you are not scheduling the appointment. We will make our best effort to schedule your appointment or contact you within two business days. If you require more immediate service please call our office at 704.861.1208

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Appointment Basics

 Me   Someone Else 


Patient Information

 Male   Female 


Appointment Details

 Yes   No 

 Yes   No, requesting first visit 

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American Dental Association           American Academy of Cosmetic Dentistry            Pankey Institute Alumni