Eric Blasingame, DDS, MS
Board Certified in Periodontology and Dental Implant Surgery
William Liska, DDS
Board Certified in Periodontology and Dental Implant Surgery
Nathan Antoine, DMD, MS
Board Eligible in Periodontology and Dental Implant Surgery
Lincoln Nguyen, DDS, MS
Board Eligible in Periodontology and Dental Implant Surgery
Michael R. Moreno, DDS
Periodontal Specialist
Andrew Lum, DMD, MS
Board Certified in Periodontology and Dental Implant Surgery
Redding 530.241.3302
Reno 775.447.1191
Stockton 209.478.4050
1
Patient Information
Imaging Provided

2
Evaluation For
Periodontal Concerns
Dental Implants
Oral Surgery
Sedation
My patient is interested in
Eric Blasingame, DDS, MS
Board Certified in Periodontology and Dental Implant Surgery
William Liska, DDS
Board Certified in Periodontology and Dental Implant Surgery
Nathan Antoine, DMD, MS
Board Eligible in Periodontology and Dental Implant Surgery
Lincoln Nguyen, DDS, MS
Board Eligible in Periodontology and Dental Implant Surgery
Michael R. Moreno, DDS
Periodontal Specialist
Andrew Lum, DMD, MS
Board Certified in Periodontology and Dental Implant Surgery
Redding 530.241.3302
Reno 775.447.1191
Stockton 209.478.4050

If you need help with this form or want to see if your patient can be seen the same day, please call our office.
Redding: 530.241.3302 | Reno: 775.447.1191 | Stockton: 209.478.4050

Redding

384 Hartnell Avenue, Suite A
Redding, CA 96002

Phone: 530.241.3302

Reno

855 W. 7th Street, Suite 130
Reno, NV 89503

Phone: 775.447.1191

Stockton

4545 Quail Lakes Drive
Stockton, CA 95207

Phone: 209.478.4050