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Going to the Dentist isn't what it used to be! Dr. John Ukich and Dr. Ronald Pflipsen
Pediatric Dental Center of North Idaho
1717 Lincoln Way, Coeur d'Alene, Idaho  83814  (208) 667-3556 (800) 366-3580

Request an Appointment
If you would like us to contact you to make an initial appointment for your child, please complete the information below and we will telephone you at the beginning of the next business day to arrange a date and time. Please indicate if this is your child's first visit to the dentist. When you make an initial new patient exam appointment, we will send your child a personalized copy of "My First Dental Visit" to help familiarize your child with our dental office and what to expect at the first appointment.
My First Visit to Pediatric Dental Center

Type of Appointment:
Emergency
New Patient Examination
Referral
Parent's Full Name:

Child's First Names:

First Dental Visit?
Yes No

First Dental Visit?
Yes No

First Dental Visit?
Yes No
First Dental Visit?
Yes No
Telephone Number:
(Include Area Code)
Your E-Mail Address:
Fax # if Applicable:
Address:
City:
State:
Zip Code:
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