Online Payment
9850 E. 79th Street
Indianapolis, IN 46256
1
Start
2
Address
3
Payment
Name
*
First
Last
Email
*
Phone
*
Billing Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Location Confirmation
*
WARNING: This practice is located in INDIANAPOLIS, INDIANA. Are you sure you are sending money to the correct practice?
I understand that this payment is being made to Davies Dental located in Indianapolis, Indiana and that if I make this transaction in error I will be responsible for all processing fees and fees incurred issuing a refund.
Credit Card
*
Card Details
Cardholder Name
Payment Amount
*
Captcha
Phone
This field is for validation purposes and should be left unchanged.
Δ
Scroll to top