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Apex Sleep Dentistry
Moses Lake
+1 (509) 766-9030
Spokane
+1 (509) 900-6300
Dr. Eugene Pester
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JUSTIFICATION FOR REFERRAL *
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Date of Last Dental Exam
Date of Last Prophy
Date of Last PerioMaint
Date of Last SRP
Date of Last Panorex
Date of Last Full Mouth X-rays
Date of Last Bitewing X-rays
Date of Last GA/IV Anesthesia
Request for patient to return to my office after work is complete
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