Request to Transfer Records to Children’s Dental Haven

Please correct the errors described below.

I request that the dental records for my child/children listed below be transferred to Jemima Poitevien, D.D.S.,P.L.L.C dba Children’s Dental Haven.

Add Additional Name

Please send records to:

Children’s Dental Haven
4225 W. Memorial Rd
Suite 101-B
Oklahoma City, OK 73134
Telephone: 405-608-8806
Fax: 405-608-8801
Email records to

Electronic medical records are preferred. If possible, please e-mail records to the e-mail listed above.

Thank You!

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