You may refer to our office by filling out our secure online Referral Form. After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. On your patient's first visit to our Harrison NY office, we will have your completed form available. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.
PC Users
Our online form uses Adobe Acrobat Reader 5 or greater plug-in to
conveniently submit the form from home or work. Please download the free plug-in
from Adobe's web site if it is not already installed on your system. It
is important that you have at least version 5 of the plug-in to
successfully use our online form.
Mac Users
You must open and submit the form in a Safari Browser with the latest
Mac operating system. It is also important to have the latest version
of Adobe Acrobat Reader on your computer in order to submit your form
to our office correctly, please download the free plug-in from Adobe's web site.
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Dr Mark Niznikiewicz | Oral Surgeon & Implant Dentist | Harrison Implant & Oral Surgery Center
351 Harrison Avenue, Harrison NY 10528 | 914-777-7171
Specializing in dental implants, wisdom teeth, TMJ disorders, bone grafting, and jaw surgery
for Westchester County including Bronxville, Eastchester, Elsmford, Harrison, Hartsdale, Hawthorne, Larchmont, Mamaroneck, Mt Vernon, New Rochelle, Port Chester, Purchase, Rye, Scarsdale, Sleepy Hollow, Tarrytown, Thornwood, Tuckahoe, Valhalla, White Plains, and Yonkers.
Oral Surgery Website Design © 2011 PBHS, Inc.