Practice Description
Dr. Dantini
Office Staff
Patient Services
Technology
Office Hours
Directions
New Patient Coupon
Frequently Asked Questions
Dental News
The Connecticut Bridge
Links
Smile Book
 

SecurityMetrics Credit Card Safe
 
CREDIT CARD PAYMENT
 
  

Please use the below form to contact us privately and securely.

To be used by patients of record only.  Billing address should be home address we have on file; otherwise, enter billing address below in message area.
 
Your  Name (as it appears on your card)
  Card Type:  
   
  Card Number:  
  Expiry Date:  
Preferred  Contact  (e-mail,  or address,  or  phone number)
Additional Message (Optional):
Please Press Submit to send your Payment Information:

Your message will be sent securely  to a private e-mail address on our own server within our private network never touching the public internet.   Charges will be submitted to our processor the next business day.  We will provide you a receipt/confirmation based on your Preferred Contact information.