">
Teledentistry Payment TEST PAGE - Higginbotham Family Dental: Higginbotham Family Dental
Call Now
Request Office Appointment
Menu
HOME
LOCATIONS
JONESBORO, AR – HILLTOP
JONESBORO, AR – SOUTHWEST DRIVE
PARAGOULD, AR
BLYTHEVILLE, AR
WEST MEMPHIS, AR
LITTLE ROCK, AR
MEMPHIS, TN – HARBOR TOWN
MEMPHIS, TN – EAST MEMPHIS
BARTLETT, TN
KENNETT, MO
OUR DENTISTS
OUR SERVICES
CLEANING/PREVENTIVE
ORTHODONTICS
COSMETIC DENTISTRY
TEETH WHITENING
SNAP-ON SMILE
SMILE MAKEOVERS
DENTAL IMPLANTS
PERIODONTAL DISEASE THERAPY
ORAL SURGERY & TMJ THERAPY
DENTURES AND PARTIALS
RESTORATIVE DENTISTRY
TOOTH COLORED FILLINGS
DENTAL CROWNS, INLAYS, & ONLAYS
DENTAL BRIDGES
FULL MOUTH RECONSTRUCTION
ROOT CANAL
SEDATION DENTISTRY
FREE DENTAL SCREENINGS
TELEDENTISTRY
AFTER TREATMENT INSTRUCTIONS
PATIENT FORMS
NEW PATIENT PAPERWORK
UPDATED PATIENT PAPERWORK
ONLINE PAYMENT
DENTAL PAYMENT PLANS
DISCOUNT DENTAL PLAN
DENTAL INSURANCE
REFERRAL PROGRAM
PATIENT PRIVACY POLICY
MEDIA
CONTACT US
CAREERS
Teledentistry Payment TEST PAGE
Please enable JavaScript in your browser to complete this form.
Name
*
Date of Birth
*
City
*
Zip
*
Address
*
US States
*
- Select State -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
ARMED FORCES AFRICA CANADA EUROPE MIDDLE EAST
ARMED FORCES AMERICA (EXCEPT CANADA)
ARMED FORCES PACIFIC
Payment Amount
Phone
*
Name on Card
*
Exp Date
*
Card Type
*
Select One
Visa/Mastercard
American Express
Visa/Mastercard Card #
*
American Express Card #
*
CVV code
*
Signature of Applicant (Type Your Name)
*
Submit
MENU
HOME
LOCATIONS
JONESBORO, AR – HILLTOP
JONESBORO, AR – SOUTHWEST DRIVE
PARAGOULD, AR
BLYTHEVILLE, AR
WEST MEMPHIS, AR
LITTLE ROCK, AR
MEMPHIS, TN – HARBOR TOWN
MEMPHIS, TN – EAST MEMPHIS
BARTLETT, TN
KENNETT, MO
OUR DENTISTS
OUR SERVICES
CLEANING/PREVENTIVE
ORTHODONTICS
COSMETIC DENTISTRY
TEETH WHITENING
SNAP-ON SMILE
SMILE MAKEOVERS
DENTAL IMPLANTS
PERIODONTAL DISEASE THERAPY
ORAL SURGERY & TMJ THERAPY
DENTURES AND PARTIALS
RESTORATIVE DENTISTRY
TOOTH COLORED FILLINGS
DENTAL CROWNS, INLAYS, & ONLAYS
DENTAL BRIDGES
FULL MOUTH RECONSTRUCTION
ROOT CANAL
SEDATION DENTISTRY
FREE DENTAL SCREENINGS
TELEDENTISTRY
AFTER TREATMENT INSTRUCTIONS
PATIENT FORMS
NEW PATIENT PAPERWORK
UPDATED PATIENT PAPERWORK
ONLINE PAYMENT
DENTAL PAYMENT PLANS
DISCOUNT DENTAL PLAN
DENTAL INSURANCE
REFERRAL PROGRAM
PATIENT PRIVACY POLICY
MEDIA
CONTACT US
CAREERS
×
Blytheville
Southwest Drive, Jonesboro
West Memphis
Bartlett, TN
Little Rock
Paragould
Kennett, MO
Hilltop, Jonesboro
Harbor Town Memphis, TN
East Memphis, TN