•  2620 Ashby Avenue, Suite 101, Berkeley, CA 94705
  •  (510)423-0748
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Periodontist - Berkeley, CA - San Francisco, CA | Dr. Chertok
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  • Gum Recession
    • -About Gum Recession
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      • --Loose Teeth
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    • -Fix Missing Teeth
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    • -Bone Grafting
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    • -Guided Tissue Regeneration
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Complete Your New Patient Paperwork Before Your First Appointment

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Patient Form Downloads

For your convenience, all new patient paperwork can be accessed online. Simply download each form below, complete the forms at home, and bring the forms with you to your first appointment. If you should have any difficulty downloading these forms, please call our office and a knowledgeable staff member will be happy to assist you.
periodontist in Berkeley, CA Financial Policies
gum disease in Berkeley, CA
 HIPPA Acknowledgement Form
dental implants in Berkeley, CA
 New Patient Form
berkeley CA Dental Implants
 Online Payment Form

Have Additional Questions? Call Now: (510) 423-0748 | Ready to Schedule Your Appointment? Click Here! 

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Contact Us

Address
Keith Chertok, DDS
2620 Ashby Avenue, Suite 101
Berkeley, CA 94705

Contact Us
Current Patients: (510) 548-0150
New Patients : (510)423-0748
Fax: (510) 548-0156
Email: info@berkeleyperiodontics.com

Office Hours

Monday: 7:30am - 5:30pm
Tuesday: 7:30am - 5:30pm
Wednesday: Closed
Thursday: 7:30am - 5:30pm
Friday: 7:30am - 5:30pm
Saturday & Sunday: Closed

Featured Services

Dental Implants
LANAP
Pinhole Surgical Technique
Gum Grafting

For New Patients

  • Meet Dr. Chertok
  • Before and After Photos
  • Patient Testimonials
  • Financial Policies



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