Call us for a consultation:
800.655.8989

123 South 3rd Ave., Ste. 4
Sandpoint, ID 83864
208-255-5667 | fax 208-255-5665
1859 N Lakewood Dr., #101
Coeur d'Alene, ID 83814
208-667-5565 | fax 208-765-9633

Oral Maxillofacial Referral Form

For your convenience, our referral communication form can be completed and returned to us to ensure quality patient care. Dr. Cullum is pleased to discuss treatment concerns at anytime.

The security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it.

Complete and submit the Implant Referral Form »