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98-76 Queens Blvd., Suite P-1, Rego Park, NY, 11374
For appointments and inquiries, please call:
(718) 897-3400


PATIENT REGISTRATION FORM (Page 1)
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EMPLOYMENT INFORMATION

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DENTAL HISTORY INFORMATION

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MEDICATIONS

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AGREEMENT 1 - Insurance

AGREEMENT 2 - Signatures

AGREEMENT 3 - Releasing of necessary personal information for securing payment benefits.

AGREEMENT 4 - For patients without insurance.

AGREEMENT 5 - Appointment cancellations and changes.


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About Dr. Maria Supnet-Gozun,DDS


Dr. Maria Gozun, DDS has been a practicing dentist for more than 25 years and is recognized as one of America's Top Dentist for 2012 - Verified by Consumer's Research Council of America.

She's a graduate of New York University and University of the East-Philippines. She keeps her professional experience updated by being a member of the Academy of General Dentistry.

Visit her at her office to experience what it means to get personalized treatment and great patient care.

What We Do


Our office provides all general dental services, examinations, diagnostics, and dental treatments catering to all ages.

Our Services
Our Team
Our Office
Office Schedule
Directions
Insurance and Payment Providers

Contact Us


Telephone: (718) 897-3400
Fax: (718) 897-3401

98-76 Queens Blvd., Suite P-1
Rego Park, NY, 11374
(corner of 66th Ave., & Queens Blvd.)

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