America’s largest denture repair service Lab
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Mail to: Denture Repair Service Lab | 27 Water St #15b | Wakefield | MA 01880, USA

First Name Last Name Phone *

Address Apt#
City State Zip Code
Email
Money Order
Credit Card # Expiration / 3 Digit Code
Signature:___________________________________________
I have read and agree to the Denture Repair Service Lab Policy and authorize Denture Repair Service Lab to charge my credit card for the services provided.
1 Tooth (you supply tooth) $39.00
2 Teeth (you supply teeth) $59.00
3 Teeth (you supply teeth) $98.00
1 Tooth ( lab supply teeth) $59.00
2 Teeth (lab supply teeth) $98.00
3 Teeth (lab supply teeth) $129.00
1 Crack/Break/Fracture $59.00
2 Cracks/Breaks/Fractures $89.00
3 Cracks/Breaks/Fractures $129.00
Duplicate Denture $279 / Duplicate Partial $329.00
Professional Cleaning & Polishing $49.00
90 Day Warranty $40.00
1 Crack/Break/Fracture $169.00
2 Cracks/Breaks/Fractures $209.00
1 Tooth (you supply) $149.00
2 Teeth (you supply) $175.00
1 Tooth (lab supply) $169.00
2 Teeth (lab supply) $195.00
Nightguard $169.00
Duplicate Denture $299.00
Duplicate Partial (non metal) $349.00
Duplicate Hard Nightguard $199.00
1Shade Whitter Teeth $35.00
Cleaning & Polishing $49.00
90 Day Warranty $45.00
Additional Instructions
Coupon Code
TOTAL
Please mail your denture to:
Denture Repair Service Lab  27 Water St   #15b

Wakefield | MA 01880