Prosthetic Demo Order Form

Please complete the form below. All fields indicated by * are required. The cost of each demo is indicated below.

Click here to learn more about our Definitive Prosthetic options!

NOTE: Demos are not for intraoral use.

Doctor Name:*

Facility Name:*

Email:*

Phone:*

NPI Lic #:*

Long Term Provisional - $375 | 10 Business Days:

Denture Teeth and Acrylic - $525 | 15 Business Days:

Zirconia - $950 | 15 Business Days:

Nano-Ceramic - $975 | 20 Business Days:

Pekkton™ Substructure with Crowns - $1,775 | 20 Business Days:

Shipping Address (Street, City, ST, Zip Code):*

Promo Code:

NOTE: Promo codes cannot be applied in conjunction with any other offers or discounted pricing.

Long Term Provisional

Denture Teeth & Acrylic

Zirconia

Nano-Ceramic

Pekkton™ Substructure with Crowns