Patient Information

to get you acquainted

Save your time by completing secure online Patient Registration Form before your appointment. This electronic form does not need to be printed. On your first visit to our office, we will have your completed form available for your review and signature. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.
Fill Out Electronic New Patient Form

Privacy Notice
Release of Records Request

No Dental Insurance?

Denisovich Dentistry In House Dental Plan – Dentistry Made Affordable!

We understand that dental care needs to be affordable, especially for families. We also know that many companies have cut back on dental benefits or even cut them out entirely. Even if you have dental insurance, you may be concerned about your out-of-pocket expenses. So we make every effort to lighten your financial burden.

In House Dental Dental Plan is one way to make dental care affordable for the whole family. There are no deductions from your paycheck every month that only pay for limited dental insurance. With Quality Dental Plan there’s only a simple annual enrollment fee.

NO annual maximum
NO deductible
NO wondering whether insurance will pay towards your treatment
NO waiting period-this means you can start treatment today!
NO preauthorization is required!
FREE dental implant consultation

Advantages In House Discount Plan Dental Insurance
Use it SAME DAY! YES

NO

No Annual Limits YES NO
No Paperwork Hassles YES NO
No Waiting for Dental Care YES NO
Cosmetic Dentistry Savings YES NO

Annual Enrollment Fee

$250 for initial plan member. $150 for each additional member*

*Spouse or Children up to 18 or if full-time in college up to the age of 26 years old living in the same household.

Your enrollment entitles you to receive:

Procedure Coverage Procedure Coverage
Dental Exam 2 per year 100% Emergency Exam (1) if necessary 100%
Full mouth series/PAN (one ever 3 yrs) 100% Bitewings (1 set per year) 100%
Periapical (first film+2 add’l / year) 100% Regular**Dental Cleanings 100%
Fluoride 50% Dental Sealants (child up to 12 y) 20%
Space maintainers 20% Fillings 20%
Crowns & Bridges 20% Dentures & Partials 20%
Root Canals 20% Periodontal Therapy (Deep Cleaning) 20%
Periodontal Maintenance(3 months visits) 20% Teeth whitening (custom trays) 50%
Veneers 20% Extractions / Oral Surgery 20%
Dental Implants 20%    

**NOT VALID WHEN PERIODONTAL DISEASE IS PRESENT

The Fine Print

  • This is a dental discount plan and is NOT dental insurance.
  • It CANNOT be combined with any other dental insurance.
  •  It is good ONLY at Denisovich Dentistry Therefore, if you are referred to a specialist, they will NOT offer this discount.
  • Payment in full is due at time of service. 
  • Any service not paid for at the time of service will be billed at usual and customary fees.
  • Cannot use with any other discounts or financing including CareCredit.
  • Non-refundable.
  • No refunds will be given if patient chooses not to use their dental plan.
  • Plan is subject to change yearly.
  • Must remain plan participant entire duration of recommended treatment. 
  • Should there be dental treatment needed following any type of injury where a lawsuit and therefore outside medical, car,  disability, or workman’s comp type insurances are involved, this discounted plan cannot be used.

Before your first visit, please complete electronic New Patient Registration online, located above

From friendly and knowledgeable dental team to simple things like soothing music, candles, blankets, coffee and wifi, we strive to make your dental visit relaxing and stress free. Enjoy a movie or a tv show from an online HULU or Netflix providers during your visit. We want to make sure your visit is comfortable!

The first visit will include a very thorough dental examination. This way we are able to diagnose your existing conditions, talk about your needs and wants and present you with your options. The doctor will examine your mouth for oral cancer, signs of dental decay, missing teeth, jaw dysfunction, any defective dental restoration(s) or hidden abscess (infection).
In addition, we will be doing a full periodontal (gum) screening to determine if any disease is present. Occasionally, some patients will require more extensive work up to create a specific solution to help them understand their options.


 In order to be as thorough as possible, digital radiographs (x-rays) will be taken along with photographs.

If your first visit to Denisovich Dentistry happens to be an emergency dental visit, we will address the cause of dental discomfort or problem and once that is taken care off, we will schedule for a comprehensive exam to discuss ways to avoid any future dental emergencies.

If you have had x-rays taken recently, please bring them with you or email them to us at smile@denisovichdentistry.com. You will need to fill out and sign “release of records request” from your previous dentist or you can use our form here: Release of Records Request

If you are experiencing anything from mild tooth discomfort to painful throbbing, it can only get worse if not treated in a timely manner. Delaying treatment can result in more severe damage and can lead to more complex and expensive treatments or surgery. But you don’t have to suffer through the pain. At Denisovich Dentistry we will do everything we can to make sure that you’re treated as soon as possible. Most of the time we can do same day treatment to alleviate your symptoms. Please call us (704) 837-7701 to schedule your visit.
Common Dental Emergencies are

  • A broken or loose tooth
  • Advanced tooth decay
  • Advanced gum disease
  • Tooth abscess
  • Damaged or dislodged tooth restoration
  • Infection that has spread to the face and other areas

When calling after regular business hours please leave a message with your name and contact information and the doctor on call will get back to you.

Aetna Dental InsuranceCigna Dental InsuranceDelta Dental InsuranceMetlife Dental Insurance

As a service to our patients, our practice accepts most dental insurance plans including Delta Dental, Cigna, Aetna, MetLife, Ameritas, Humana, and Assurant. Please call to check if your plan is not listed! We are experts at working with insurance providers to make sure you and your family get all the dental care you need. We will also e-file dental claims for you!

Dental insurance is very different from typical medical insurance coverage. For most preventive services, dental insurance may pay as much as 100% but only 30% for other major procedures. This is based on the contract between your employer and the dental insurance company.

Our patients take an active role in discussing with Dr. Denisovich their desires and choices for their dental health. Our office believes that patients should make their own treatment decisions regarding dental care and not influenced solely by insurance company coverage or policies.

When using dental insurance, we will first verify your coverage prior to any services completed. We ask that you pay your portion at time of service and we will file and accept assignment from your insurance carrier. Our staff will gladly submit a pre-treatment estimate to your insurance company for any major work. Remember that your insurance policy is an agreement between you and your insurance provider, and therefore you are responsible for the payment of all professional fees regardless of the extent of coverage.

Our goal at Denisovich Dentistry is to make dental health a financial possibility for all of our patients. We offer affordable fees and a variety of convenient payment options that fit every budget.
Our office accepts Cash, Visa, Master Card, Discover and American Express.
We offer flexible financing through CareCredit with 6 or 12 months no interest to pay for the treatment. Visit the CareCredit website for more information.
We also offer an In House Dental Plan for self pay patients where you can save 20% on all dental care for you and your family.