Frenectomy Referrals

Contact our pediatric dental offices today to learn more about our dentists or to request an appointment.

Mitten Kids Dentistry – Grand Rapids

1179 East Paris Ave SE #130
Grand Rapids, MI 49546

Fax: 616.942.0170

616.942.9840

Mon, Tue, Thu: 8 AM – 5 PM
Wed: 8 AM – 3 PM
Fri: 8 AM – 2 PM
Lunch Daily: 1 PM – 2 PM

Mitten Kids Dentistry – Caledonia

6477 Cherry Meadow DR SE #4
Caledonia, MI 49316

Fax: 616.942.0170

616.942.9840

Tue, Thu: 8 AM – 5 PM
Wed: 8 AM – 3 PM
Lunch Daily: 1 PM – 2 PM

Enter Your Frenectomy Referral Below

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Referred By:*

Referring Provider Phone #:*

Referring Provider Email:*

Patient's First Name:*

Patient's Last Name:*

Patient DOB:*

Guardian's First Name:*

Guardian's Last Name:*

Phone #:*

Significant Health History:*

Primary Concerns (please list):*

Referral For:*

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Upon receiving this referral, we will call the patient's guardian to schedule an appointment. Any additional information should be sent to smiles@mittenkids.com.

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