Contact Us

Our In't phone : +66 2664 2800
Our email address : contact@thaiimplantcenter.com
Your Information
  Mr. Mrs. Miss.
First Name : *
Last Name : *
Age :
E-mail 1 : *
E-mail 2 :
Country :
Phone :
Appointment Date
Date
   DD- MM -YYYY
Time
 
What hotel you’ll stay in Thailand this time?
Hotel / Guest House / Apartment
 
Have you ever visit us before?
  Yes No
Which branch you are interested to visit us?
  Bangkok Smile Dental Clinic
Sea Smile Dental Clinic
Your Requirement
  Make an Appointment
Ask for a Quotation
Make a Consultation online
Dental Implant (You can choose more than one)
 
Single tooth implant(s)
Multiple teeth implants (with porcelain bridge)
Immediate implants (full jaw) -all on 4 / all on 6 / zygomatic implant
Implants-Overdenture
Other
Dental Treatment (You can choose more than one)
 
“Truly” laser teeth whitening Porcelain Veneer
Check up Filling
Cleaning Root canal treatment
Crown&Bridge Gum treatment
Extraction Orthodontics(Braces)
Invisalign Consultation
Other :
If you want to send our dental specialists your x-rays , pictures or dental records, please send directly to our email below:
More details :
  I want to know more about the dental guarantee for oversea clients
To make sure that you will receive our email, please add our following email address , contact@thaiimplantcenter.com into your address book. Please also review your Spam filters that might be loaded on your system so as to allow our response.
IN CASE OF EMERGENCY, please call us at 0 2664 2800.
In case of temporarily down ,
please use the other registration form at http://www.dentalthailand.com/contact.html

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