Test Husam Elias D.M.D., M.D., FAC Oral Surgeon Darren Smolkin, D.M.D Endodontist Fardad Tayebaty, D.M.D. Endodontist Guneet Kohli Kainth, DDS, MBA Orthodontist Eric Osmolinski D.D.S. Oral Surgeon David Hwang D.D.S Endodontist Dr. Daniel Lin Periodontist Dr. Abbas Doctor Periodontist Please enable JavaScript in your browser to complete this form.Patient Name *Patient Phone *Patient Email *Referring Doctor Name *Referring Doctor Phone *Referring Doctor Email *Office *SelectSanta ClaraEast San JoseSouth San JoseSalinasGilroySeasideWatsonvilleConsultation ForSelectOral SurgeryOrthodonticsEndodonticsPeriodonticsEnter the Tooth/Teeth to be treatedNotesAttach ImageSubmit