GENTILE DENTAL CARE

89 Grand Avenue
Massapequa, NY 11758
(516)639-6975 phone
DonnaGentileDDS.com
GentileDentalCare@Outlook.com

ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES


*YOU MAY REFUSE TO SIGN THIS ACKNOWLEGEMENT

I, have reviewed a copy of the notices of privacy practies.


Please Print Name


Signature


Date


For Office Use Only


We attempt to obtain written acknowledgement to receipt of our privacy practices,our acknowledgement could not be obtained because:

Individual refuse tosign.

communication barriers prohibited acknowlegement.

An emergency situation prevented us from obtaining acknowledgement.

other(please specify).

Gentile_Dental_Care_Logo
GentileDentalCare

A prosthodontist is a dentist who specializes in the esthetic restoration and replacement of teeth.

Our Awards
Social Networks

Our staff is professional and courteous with everyone who walks through our doors. We strive to give exemplary care in our practice by communicating with our patients and agreeing on a treatment plan that best suits them aesthetically, and financially.

Copyright 2020 by BoldThemes. All rights reserved.