When making a referral for a dental appointment, complete a certified referral form in its entirety.

After the form has been filled out completely, signed and dated, make the appointment for your client.  Do Not Fax the referral form to the dental office or your contract coordinator until the appointment has been made. When making the appointment please identify that the appointment is for a Ryan White client to ensure appropriate billing stream.

Once you have made the appointment with either provider Charlotte Dental or First Dental of Huntersville; the referral must be faxed to be the dental office and to the administrative assistant in the Ryan White Office, (704) 432-5274. 

Charlotte Dental Associates - University Area office
8220 University Executive Drive, Suite 111
Phone: (704) 548-8563
Fax: (704) 510-2793

First Dental of Huntersville - Huntersville office
Contact Person: Amanda
16511 Northcross Dr. Suite F, Huntersville
Phone: (704) 987-7996
Fax: (704) 987-9669

First Dental of Huntersville - Pineville office
Contact Person: Katie
10700 Kettering Dr. Suite A
Pineville, NC 28226
Phone: (704) 540-5440
Fax: (704) 540-5441

Please note that fiscal responsibility for incomplete Certified Referral forms rests with the referring agency. If you have any questions please contact your Contract Coordinator.