La Luxe Dental - Online Payment Form

Thank you!

Your payment of was processed successfully. We've sent a receipt to your email.

Transaction ID:

There was an error processing your payment.

Please use patient information you have on file with us.

Amount

$

Patient First Name

Patient Last Name

Email

Phone

Note

There was an unepxected error.

La Luxe Dental
1050 First Street Northeast
Suite 101
Washington, DC 20002

202-918-1204

Powered by Moolah. Payments are secured using SHA-256 RSA SSL encryption.

Privacy Policy