604-464-1511
info@coquitlamcentredental.com
1244-2929 Barnet HWY
Coquitlam, BC V3B 5R5
Coquitlam Centre Dental Clinic
We thank you for your trust in our team. If you would like to refer a patient to us, please select the practitioner below and fill out the digital referral form. We will be in touch with your patient within 48 hours.
Dr. Nariman Amiri - Prostho
Dr. Ben Pliska - Ortho
Prosthodontic Referral
Dr. Nariman Amiri
This information will be considered confidential and is for our purposes only.
Patient’s Name
Parent/Guardian Name
Patient's address
Insurance Information
Policy holder name
Referring doctor name
Orthodontic Referral
Dr. Ben Pliska