(716) 317-5831

Please fill out the information below.

First Name *

Last Name *

Phone *

Email *

Physical Address *

City *

State *

Postal code *

How Many Teeth Are You Looking To Replace *

All of them

1-3 Teeth

4-6 Teeth

Full Upper Set

Full Lower Set

What Type Of Replacement Options Are You Looking For? *

Teeth that are permanent meaning they don't come in and out (More Expensive)

Teeth that are removable (Less Expensive)

Are You Currently Experiencing Pain? On The Scale Of 1-10 How Much Pain Are You Experiencing *

7-10 (Very Painful) Emergency

4-7 (Moderately Painful) You need to be seen soon

1-4 (Low Pain) Lets hurry before it gets worse

Have You Ever Been Told You Do Not Have Enough Bone? *

Yes (Don't worry, we have many options other dentists don't have, to get you permanent teeth)

Dental Implant procedures are not always covered by insurance. However, many affordable payment plan options exist. Are you interested in a payment plan option? *

Yes (We can help you determine what options you have)

No Thanks I have that part figured out

I have Medicare

I have Medicaid

Payment Plans Are Available Based On Credit Approval Of The Patient Or A Co-Signer. Which Option Describes Your Credit Score? *

700+ (Very Good)

650-700 (Good)

600-650 (Still Possible depending on need)

600 or Less (Might Be Difficult)

I have a Co Signer that will help me qualify

Monthly Budget *

$50-$100 Per Month

$100-$250 Per Month

$250-$500 Per Month

$500-$750 Per Month

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Igor Kaplansky,

DDS, FAGD, FICOI

General Dentistry, Oral Surgery, Dental Implants, Orthodontics, Endodontics

Komal Koli,

DDS, MS

General, Cosmetic and Pediatric Dentistry

Samantha Smith,

DDS

General, Cosmetic and Pediatric Dentistry

8038 Rochester Rd, Gasport, NY 14067, USA

DENTISTRY BY

DR. KAPLANSKY, PLLC

8038 Rochester Rd

Gasport, NY 14067

Phone: (716) 317-5831

HOURS

Mon 8:00AM - 8:00PM

Tue 8:00AM - 8:00PM

Wed 8:00AM - 8:00PM

Thu 8:00AM - 8:00PM

Fri 8:00AM - 3:00PM

DENTISTRY BY

DR. KAPLANSKY, PLLC

8038 Rochester Rd

Gasport, NY 14067

Phone: (716) 772-7500

HOURS

Mon

Tue

Wed

Thu

Fri

8-5

8-3