To pay online please complete the form below and click the Make A Payment button. You will be directed to our secure payment page. To recieve a receipt, please allow pop-ups on that page. Thank you.

*Full Name:

*Billing Street Address:

Billing Apartment / Suite Number:

*Billing City:

*Billing State:
(format = UT, CA, CO)
*Billing Zip Code:

*Billing Phone Number:
(format = 111-222-3333)

*Provo Pediatric Dental Account Number:


Contact Us Today

We are honored to serve the local community with friendly and energetic care. Our team offers a one-of-a-kind experience for you and your child to help you feel fully involved with your child’s smile adventure. Call us today to get started on your first visit!

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