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America's largest denture repair service.
ORDER FORM
Questions? 1-888-349-6695
Complete order form and click print button to print out the form. Credit card information is optional we can obtain it over the phone once denture is recieved. Shipping is free with prepaid label. Overnight shipping is suggested. We ship back with free USPS Priority mail. Upgrade to USPS Express for $30.
Mail to: Denture Repair Lab | 541 Newport Ave | Pawtucket RI 02861
Customer Information
First Name *
Last Name *
Phone - - *
Address *
Apt# *
City
State
Zip Code
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Money Order
Credit Card #
Expiration /
3 Digit Code
Signature:___________________________________________
I have read and agree to the Denture Repair Lab Policy and authorize Denture repair Lab to charge my credit card for the services provided.
I have read and agree to the Denture Repair Lab Policy and authorize Denture repair Lab to charge my credit card for the services provided.
Denture Repair / Partial Repair
Glue Removal $29.00
Metal Reinforcement $29.00
Professional Cleaning $49.00
90 Day Warranty $45.00
1 Crack/Break/Fracture $89.00
2 Cracks/Breaks/Fractures $125.00
3 Cracks/Breaks/Fractures $155.00
Rebuild Gum Area w/ New Acrylic $189.00
Duplicate Denture $349.00
Duplicate Partial $399.00
Denture Teeth Repair
Glue Removal $29.00
Metal Reinforcement $29.00
Professional Cleaning $49.00
90 Day Warranty $45.00
1 Tooth (you supply tooth) $95.00
2 Teeth (you supply teeth) $135.00
3 Teeth (you supply teeth) $185.00
Duplicate Denture $349.00
1 Tooth ( lab supply teeth) $115.00
2 Teeth (lab supply teeth) $185.00
3 Teeth (lab supply teeth) $225.00
Duplicate Partial $399.00
Flexible Partial Repair
Glue Removal $29.00
Metal Reinforcement $29.00
Professional Cleaning $49.00
90 Day Warranty $75.00
1 Crack/Break/Fracture $219.00
2 Cracks/Breaks/Fractures $259.00
Duplicate Partial $399.00
1 Tooth (you supply) $185.00
2 Teeth (you supply) $215.00
1 Tooth (lab supply) $205.00
2 Teeth (lab supply) $235.00
Duplicate Denture / Duplicate Partial
Duplicate Denture $349.00
Duplicate Partial (non metal) $399.00
Duplicate Hard Nightguard $349.00
1Shade Whitter Teeth $35.00
Professional Cleaning $49.00
90 Day Warranty $45.00
Total
Additional Instructions
Coupon Code
Please mail your denture to:
Denture Repair Lab
541 Newport Ave
Pawtucket RI 02861
Please DO NOT send in your denture boxes, dental containers or any other containers along with your dentures/partials, since it will not be returned due to shipping weight restrictions.