Download EAST HAMPTON DENTAL GROUP PREFERRED PROVIDER PLAN

Plan Requir ements
& Limita tions
EAST HAMPTON
DENTAL GROUP
PREFERRED
PROVIDER PLAN
The Preferred Provider Plan is
available to all families and individuals who pay the annual subscriber fee. The annual plan fee
must be paid in full when submitting the application. Enrollment
Family & Individual Plans Available
is open to all.
Your plan year will be determined by the date when you submit your payment and will be for
a 12 month period.
This is an independent dental
plan, offered by a private practice and we are not associated
with any other office. We reserve
the right to cancel or make
changes to the plan at any time.
Only dental services provided at
East Hampton Dental Group are
covered by this plan. Care Credit
can not be used as form of pay-
East Hampton Dental Group
56 The Circle
East Hampton , NY 11937
ment. After 45 days, cost of plan
is not refundable, but can be used
as credit for services.
Jan. 2015
Phone: 631-324-6800
Fax: 631-324-7744
East Hampton Dental Group
631-324-6800
www.ehdental.com
Plan Pricing
Services Provided
We utilize state-of-the-art techniques, materials and advanced technology to attend
to all your comprehensive dental needs.
Our team of dentists and dental specialists
provide:

General Dentistry

Advanced Restorative Dentistry

Cosmetic Dentistry

Oral and Maxillofacial Surgery

Dental Implants

Invisalign Orthodontics

I.V. Sedation (sleep dentistry)

Periodontics (gum treatment)

Endodontics (root canal treatment)

Pediatric Dentistry

Digital radiographs

Oral Cancer Screening

Teeth Whitening

In-Office ICAT radiograph

Saturday hours

24 hour emergency answering service
Individual Plan—1 Adult
Per 12 month period
Two dental cleanings with examinations, 1 full-set of
radiographs or 4 check-up X-rays + panoramic x-ray,
oral hygiene instruction, oral cancer screening, nutritional counseling, one emergency exam with x-ray.
$425
Teen Plan—13 to 19 years
Per 12 month period
Two dental cleanings with examinations, 1 full-set of
radiographs or 4 check-up x-rays + panoramic x-ray,
oral cancer screening, oral hygiene instruction, nutritional counseling, one emergency exam with x-ray,
screening for braces. $375
Child Plan—up to 12 years
Per 12 month period
Two dental cleanings with examinations and fluoride
treatment, 1 full-set of check-up x-rays, oral hygiene
instruction, oral cancer screening, nutritional counseling, one emergency exam with x-ray, screening for
braces. $340
Family Plan—4 people
Per 12 month period
Dentists and Dental Specialists
David A. Mambrino, D.D.S.
Advanced Restorative & Cosmetic
Dentistry
Ven Sampathkumar, D.D.S.
Advanced Restorative & Cosmetic
Dentistry
Navid Rahmani, D.D.S.
practice limited to Periodontics and
Dental Implants
Jack A. Nelson, D.D.S.
practice limited to Oral Surgery, Dental
Implants and Dental Anesthesiology
Dental Hygienists
Tara Turner R.D.H.
Nicole Kalafut, R.D.H.
A private preferred provider plan
offered by East Hampton Dental Group
Two dental cleanings with examinations, 1 full-set of
radiographs or 4 check-up x-rays + panoramic x-ray,
fluoride treatment, oral hygiene instruction, oral cancer screening, nutritional counseling, screening for
braces and one emergency exam with x-ray.
$1475
East Hampton Dental Group
All plans include a 15% discount on restorative
and endodontic treatment and a 10% discount on
oral and periodontal surgery and orthodontic
treatment.
Phone: 631-324-6800
Fax: 631-324-7744
E-mail: [email protected]
56 The Circle
East Hampton, NY 11937
www.ehdental.com