Check out our latest Work Gallery – Lofts Dental Care Langhorne PA

Full Name*
Phone*
Email*
Reason For Appointment*
Please provide some details about your visit
Preferred Day Of The Week*
Appointment Time*
Dental Insurance*
No Insurance! No Problem! We recommend to ask for our membership plan that gives up to 20% discount.
Insurance Carrier*
Member ID or SSN*

Also known as Subscriber ID or Member Id
Group Name

Provide Group Name or Group Name or Employer as it helps us to identify right plan very quickly
Insurance Card Front
Accepted file types: jpg, gif, png, pdf, Max. file size: 64 MB.
Front side of your Insurance Card
Insurance Card Rear
Accepted file types: jpg, gif, png, pdf, Max. file size: 64 MB.
Back side of your insurance card
Date Of Birth*
Month
Day
Year
How much is 5 + 4?*
Enter the right answer and Submit button will get visible.
Name
This field is for validation purposes and should be left unchanged.

Hours Of Operation

Mon - Fri: 9:00 am - 5:00 pm
Sat: 9:00 am - 12:30 pm
Sun: Closed

(267) 300-0007

Gallery