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DENTAL TREATMENT REFERRAL Child’s Name:______________________________________________________ Screening Date:__________________ Future Smiles, a 501 (c)(3) Nevada non-profit, is a school-based program that provides preventive oral health care (dental cleaning, fluoride and sealants) to low income, uninsured, Medicaid/CHIP children in the Clark County School District. Your child was seen today by one of our Public Health Dental Hygienists to assess your child’s oral health. Section 1: Dental Charting KEY: S = Sealant placed A = Abscess P = Pain D = Possible decay Future Smiles is a prevention based dental hygiene program and does not provide restorative dental care (fillings/crowns). Please take this document to your child’s dentist on their next appointment. If you do not have a dentist the following is a network of community dental clinics that can provide an annual dental examination by a dentist, treatment and restorative dental care: Children’s Dentistry of Henderson 220 E. Horizon Drive, Suite H Henderson, NV 89015 (702) 565-1230 Accepts Medicaid Children’s Dentistry of North Las Vegas 4080 N. Martin Luther King Blvd 101B North Las Vegas, NV 89032 (702) 832-0508 Accepts Medicaid Children’s Dentistry of Pahrump 1017 E. Basin Ave, Suite 1 Pahrump, NV 89060 (775) 751-2184 Accepts Medicaid Dental Care International 1750 Wheeler Peak Drive Las Vegas, NV 89106 (702) 272-1100 Offers Pediatric, Family, & Orthodontic Care Children: birth to 14 yrs of age (sliding fee scale) Adults: 15 years of age and up (low cost) Nevada Health Center Eastern Family Medical and Dental Center 2212 S. Eastern Ave Las Vegas, NV 89104 (702) 735-9334 Any age; Medicaid; sliding fee scale Positively Kids Clinic 701 N. Pecos Blvd, Building M Las Vegas, NV 89101 (702) 455-4094 UNLV School of Dental Medicine Pediatric Dental Clinic Call for appointment and fees 1700 W. Charleston Blvd Las Vegas, NV 89106 (702) 774-2415 Future Smiles | 3074 Arville Street | Las Vegas, NV | 89102 | O (702) 889-3763 Email: [email protected] | Web: www.futuresmiles.net Children: birth to 13 years of age Future Smiles | 3074 Arville Street | Las Vegas, NV | 89102 | O (702) 889-3763 Email: [email protected] | Web: www.futuresmiles.net
