Implant Parts Order Form

This is a listing of our most commonly ordered parts; we do have other systems and parts in stock as well, please call (425) 822-2245 or email implants@nakanishidentallab.com to discuss!

"*" indicates required fields

Doctor’s First Name*

Doctor’s Last Name*

Practice Name*

Email*

Phone*

Address*

City*

State*

Zipcode*

Patient's First Name*

Patient's Last Name*

Delivery Date*

Impression Type*

Implant Company*

Astra System*

Astra TX Size*

Astra EV Size*

Biomet 3i System*

Biomet 3i External Size*

Biomet 3i Certain Size*

Biohorizons System*

Biohorizons Internal Size*

Biohorizons External Size*

Hiossen System*

Nobel Biocare System*

Nobel Biocare Conical Connection Size*

Nobel Biocare Replace Sheet Size*

Nobel Biocare Branemark Size*

Straumann System*

Straumann BL/BLT (Bone Level)*

Synocta (Tissue Level)*

Straumann BLX Size*

Zimmer System*

Zimmer TSV Size*

Upload Surgical Report (optional)

Accepted file types: pdf, Max. file size: 50 MB.

Comments

SMS Consent*

I consent to receiving communications from Nakanishi Dental Lab at the provided phone number.

For New Customers

For Existing Customers