Membership Enrollment - Northern Westchester Dental Care

Our New Membership Enrollment

At Northern Westchester Dental Care, we understand that only some people have dental insurance available to them, so we have developed the NWDC Membership Plan for our families of patients without access to it. Keep in mind this is not dental insurance. Our membership plan allows you to make dental care a priority at an affordable cost!

First Name & Middle Initial *

Last Name *

Sex

Male Female

Address

City

State

Zip Code

Phone Number *

Email *

Date of Birth *

Spouse's First Name & Middle Initial

Spouse's Last Name

Sex

Male Female

Spouse's Date of Birth

Enrollment Period (Month / Year - Month / Year)

Please List All Children you with to Enroll Name

Credit Card Type

Card Number

Expiration Date

Signature *

If you are having a DENTAL EMERGENCY call the office phone number directly – 914-245-3103.

Business Hours

Mon-Fri: 8:00 am – 5:00 pm
Tue: 8:00 am – 7:00 pm
Sat: 8:00 am – 1:00 pm

Contact Us

phone: 914.245.3103

emergencies: 914.924.1474

fax: 914.245.3216

Front@NWdentist.com

Location

3505 Hill Blvd., Suite F
Yorktown Heights, NY 10598

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